Novel drug therapy may cure common hormonal cause of high blood pressure

A study led by Queen Mary University of London reveals that a 6-to-12-month course of extended aldosterone synthase inhibition (EASI) can permanently reverse primary aldosteronism, curing a major hormonal cause of high blood pressure without surgery or lifelong medication

Published in the New England Journal of Medicine (NEJM), the follow-up investigation reveals that extended aldosterone synthase inhibition (EASI) for 6 to 12 months causes sustained reversal of excess aldosterone production, eliminating the need for lifelong antihypertensive medication or invasive adrenal gland surgery.

Mechanism of action and clinical evidence

Primary aldosteronism accounts for 5% to 10% of global high blood pressure cases. It occurs when benign nodules in the adrenal glands overproduce aldosterone, signalling the kidneys to retain excess salt and elevating systemic blood pressure.

The study builds on a 2005 mouse model showing that deleting the aldosterone synthase gene causes aldosterone-producing cells to regress:

Sustained high blood pressure remission post-treatment

Tracking 14 patients across eight U.S. clinical centres for up to two years after stopping EASI medication, researchers observed that excess aldosterone markers remained 99% lower than baseline pre-treatment levels.

Significant blood pressure reduction

Follow-up data revealed an average blood pressure reduction of 25 mmHg post-treatment. Nearly a quarter of study participants achieved completely normal blood pressure without taking any antihypertensive drugs.

Non-surgical cure

Historically, a permanent cure for primary aldosteronism required invasive adrenalectomy (surgical removal of an entire adrenal gland). EASI therapy achieves comparable biochemical remission via a once-daily oral pill.

The ELIXIR Trial and future outlook

While conventional hypertension management relies on lifetime symptom suppression, EASI treatment targets the biological cause of cellular hypersecretion. The prolonged 6-to-12-month treatment window appears to induce regression or atrophy of the hyperactive aldosterone-producing cells within the adrenal cortex.

Building on these findings, the research team is initiating ELIXIR, a larger prospective clinical trial. The trial will utilise advanced molecular imaging of the adrenal glands to visually track whether extended aldosterone synthase inhibition permanently eliminates the underlying nodular cell populations.