Systemic
hypertension (HTN) is the hallmark of
cardiovascular disease and the forerunner of
heart failure. These associations have been established over decades of research on essential HTN. Advancements in the treatment of patients diagnosed with HTN, consisting of alpha- or
beta-adrenergic receptor blockers, calcium channel blockers,
angiotensin-converting enzyme inhibitors,
thiazide, or
aldosterone receptor blockers known as anti-
mineralocorticoids, in the presence or absence of low
sodium salt diets, often fail to control blood pressure adequately to prevent morbidity and mortality.
Low sodium diets have had limited success in controlling HTN because low
sodium intake is associated with renin-angiotensin-aldosterone system upregulation. Therefore, upregulating
aldosterone secretion,
sodium, and water retention which, in turn, moves the blood pressure back toward the range of HTN dictated by the baroreceptor reset value, as a compensatory mechanism, especially in resistant HTN. These impediments to blood pressure control in HTN may have been effectively circumvented by the advent of a new class of drugs known as
aldosterone synthase inhibitors, represented by baxdrostat. The mechanism of action of baxdrostat as an
aldosterone synthase inhibitor demonstrates the inextricable linkage between
sodium and blood pressure regulation. Theoretically, combining a
low sodium diet with the activity of this
aldosterone synthesis inhibitor should alleviate the adverse effect of renin-angiotensin-aldosterone system upregulation.
Aldosterone synthesis inhibition should also decrease the oxidative stress and endothelial dysfunction associated with HTN, causing more endothelial
nitric oxide synthesis, release, and vasorelaxation. To the best of our knowledge, this is the first systematic review to summarize evidence-based articles relevant to the use of a novel
drug (
aldosterone synthase inhibitor) in the treatment of HTN and
cardiovascular disease. Making the current database of relevant information on baxdrostat and other
aldosterone synthase inhibitors readily available will, no doubt, aid physicians and other medical practitioners in their decision-making about employing
aldosterone synthase inhibitors in the treatment of patients.