2) During 2025 you learned about these developments from @PamTaubMD & @edgarvlermamd đ”đ. You can still earn đcredit at https://t.co/36ZYdDsq8G. Our look back is led by #cardiometabolic expert Muthu Vaduganathan @mvaduganathan, #Cardiologist @BrighamWomens @harvardmed. pic.twitter.com/DiADKojlQJ
— cardio-met (@cardiomet_CE) February 17, 2026
4a) So what do you know? #ASIs are in development for difficult-to-control #htn mainly because they:
— cardio-met (@cardiomet_CE) February 17, 2026
A. Block MR like spironolactone & eplerenone
B. â aldosterone synthesis while sparing cortisol
C. Inhibit renin release
D. Cause direct NO-mediated vasodilation
4c) 3⣠In the #BaxHTN trial, how did #baxdrostatâs #BP-lowering effect in pts with #CKD compare to those without CKD?
— cardio-met (@cardiomet_CE) February 17, 2026
A. Significantly less benefit in CKD
B. Consistent benefit in both groups
C. Only effective in non-CKD
D. Increased adverse events, no benefit
6a) There are differences in terminology amongst the various guidelines around terms such as #resistant, #refractory, or #uncontrolled #HTN pic.twitter.com/GPBJaVKJ6H
— cardio-met (@cardiomet_CE) February 17, 2026
6c) This term is broader than #resistant HTN; includes pts where control is possible but requires intensive management due to factors like suboptimal adherence, lifestyle challenges, frequent med changes, or exacerbating conditions (eg obesity, sleep apnea, high salt intake).
— cardio-met (@cardiomet_CE) February 17, 2026
7b) âAldosterone dysregulationâ refers to more subtle, reninâinappropriate aldosterone excess that can exist across the BP continuum. #ASIs in development for #htn target the full spectrum of aldosteronism including classic #PA (such as in #BaxPA) and subclinical aldosteronism
— cardio-met (@cardiomet_CE) February 17, 2026
9a) Both #MRAs and #ASIs target aldosterone biology, but at different levels: MRAs block the #mineralocorticoid receptor #MR (often activated by aldosterone and cortisol), whereas ASIs inhibit upstream aldosterone synthesis (CYP11B2) in the adrenal gland. pic.twitter.com/tGsgvhjQeq
— cardio-met (@cardiomet_CE) February 17, 2026
10a) #ASIs lower circulating #aldosterone and may help limit âaldosterone breakthrough,â with trials still defining their comparative BP, renal, and safety profiles.
— cardio-met (@cardiomet_CE) February 17, 2026
11) So let's address 2025 #baxdrostat data first:#BaxtHTN was presented at #ESC2025 and simulpub'd in @NEJM: đhttps://t.co/qMQdiHNvmX.#Bax24 was presented at #AHA2025. pic.twitter.com/abf4Z2RqhJ
— cardio-met (@cardiomet_CE) February 17, 2026
12b) #Baxdrostat was studied as onceâdaily addâon therapy vs placebo, with primary endpoints focused on changes in seated/office #SBP from baseline to 12 weeks. pic.twitter.com/7UAm1d93nH
— cardio-met (@cardiomet_CE) February 17, 2026
12d) Intriguingly, after #ASI withdrawal, serum #aldosterone levels remained suppressed for weeks with associated continued BP control pic.twitter.com/T7ucI3Uzci
— cardio-met (@cardiomet_CE) February 17, 2026
13a) The primary objective of #Bax24 was to evaluate effect of #baxdrostat 2mg once daily on 24h ambulatory #SBP at 12wk in pts w/resistant #HTN confirmed by #ABPM
— cardio-met (@cardiomet_CE) February 17, 2026
(See đhttps://t.co/Mb1FBDSGt8) pic.twitter.com/GhrPFLaEIZ
13c) Safety in #Bax24 was similar to that seen in #BaxHTN pic.twitter.com/9ztloYQa8B
— cardio-met (@cardiomet_CE) February 17, 2026
14b) Across these studies, baxdrostatâs benefit appears additive to ACEi/ARB, CCBs, and thiazides, reinforcing aldosterone synthase inhibition as a strategy for difficultâtoâcontrol #htn while highlighting hyperkalemia & kidney function as the main onâtarget issues to monitor.
— cardio-met (@cardiomet_CE) February 17, 2026
15b) Launch-HTN was presented at #ESH2025 and then published in @JAMA_current: đhttps://t.co/pD8ukzVhIZ. pic.twitter.com/3CsachYpkd
— cardio-met (@cardiomet_CE) February 17, 2026
16b) Efficacy: Placebo-adj change in #SBP was â7.9 mm Hg (97.5% CI, â13.3 to â2.6) in the stable-dose group & â6.5 mm Hg (â11.8 to â1.2) in the dose-adjustment group. In the combined lorundrostat groups baseline to w12, SBP change was â5.3 mm Hg (â8.4 to â2.3). pic.twitter.com/hzPd1E3Uac
— cardio-met (@cardiomet_CE) February 17, 2026
17a) The objective of the Ph 3 #Launch_HTN trial was to evaluate the efficacy &safety of #lorundrostat for lowering BP when added to a prescribed regimen of 2-5 antihypertensive medications in adults with uncontrolled or treatment-resistant #hypertension. pic.twitter.com/OYO58O4Xcs
— cardio-met (@cardiomet_CE) February 17, 2026
17c) The least-squares mean change in office #SBP at wk6 was â16.9 mmHg (95% CI, â19.0 to â14.9 mmHg) for the pooled 50mg lorundrostat group vs â7.9 mmHg (â11.5 to â4.2 ) for the placebo group; between-group mean difference was â9.1 mmHg [â13.3 to â4.9 mmHg], Pâ<â.001. pic.twitter.com/MsyZcfjEJ4
— cardio-met (@cardiomet_CE) February 17, 2026
17e) The authors concluded that the efficacy & safety of #lorundrostat, was demonstrated for lowering BP in adults with uncontrolled #hypertension, including those with treatment-resistant hypertension.
— cardio-met (@cardiomet_CE) February 17, 2026
18b) Lorundrostatâs BPâlowering effect appears consistent across doses & subgroups, with acceptable safetyâsupporting aldosterone synthase inhibition as a viable new strategy alongside #MRAs for difficultâtoâcontrol htn.
— cardio-met (@cardiomet_CE) February 17, 2026
20) While open questions remain regarding their comparative efficacy and safety against established MRAs, #ASIs are actively being studied across the cardio-kidney-metabolic spectrum including in the prevention of HF and in the treatment of #HF and #CKD.
— cardio-met (@cardiomet_CE) February 17, 2026
21) So, congratulations! đ„łđ You just earned 0.75hr đ CE/#CME and you can claim it right now â±ïžat https://t.co/4aS7T4YJpC! Thank you for joining us, please FOLLOW US for MORE #MedEd, and đ«Ąto our expert author @mvaduganathan! pic.twitter.com/EZ70sKZiNS
— cardio-met (@cardiomet_CE) February 17, 2026