High blood pressure, also known as hypertension, is a common health problem that can lead to serious conditions like heart disease, stroke, and kidney failure. For many people, taking medications can help manage their blood pressure. However, some individuals find it difficult to control their blood pressure even when taking multiple medications.
A recent study called the Advance-HTN trial has explored a new treatment option for people with uncontrolled and treatment-resistant hypertension. The study looked at the effectiveness and safety of a drug called lorundrostat, which works differently from current blood pressure medications. The findings of this trial were shared at the American College of Cardiology Annual Scientific Session in March 2025.
How the Study Was Conducted
The Advance-HTN trial involved 285 participants at 103 locations in the United States. These participants were already taking two to five different blood pressure medications, but still had elevated blood pressure. The study participants were divided into three groups:
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One group received a placebo, which is an inactive substance with no medicinal value.
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The second group received 50 mg of lorundrostat daily.
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The third group started with 50 mg of lorundrostat daily, but their dosage could be increased to 100 mg daily if their blood pressure remained uncontrolled after four weeks.
The study lasted for 12 weeks, during which the researchers monitored the participants’ blood pressure and looked for any side effects. The average age of the participants was 60 years old, 40 percent were women, and 53 percent were Black or African-American.
Oscar Cingolani, MD, director of the hypertension program at Johns Hopkins Medicine, told NBC News that having a high number of Black participants was “a big, big thing,” noting that “African Americans … tend to be more responsive to this pathway.”
What the Study Found
The main goal of the study was to see how much the drug changed the participants’ average systolic blood pressure (the top number in a blood pressure reading) over 24 hours. The results showed that lorundrostat was effective in lowering blood pressure:
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The group that received the placebo had their systolic blood pressure reduced by 7.4 points.
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The group that received 50 mg of lorundrostat had their systolic blood pressure reduced by 15.4 points.
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The group that had their lorundrostat dose increased to 100 mg saw a 13.9 point reduction in systolic blood pressure.
The study also looked at other factors, such as how blood pressure changed at different times and how many people reached a target blood pressure level. Lorundrostat showed positive results in these areas as well.
Important Safety Information
While lorundrostat was effective in lowering blood pressure, the researchers also noted some potential safety concerns. There was an increased risk of hyperkalemia (high potassium levels in the blood) in the groups treated with lorundrostat. The risk was higher with the higher dose.
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No one in the placebo group developed hyperkalemia.
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5 percent of participants in the 50 mg lorundrostat group developed hyperkalemia.
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7 percent of participants in the group that increased to 100 mg lorundrostat developed hyperkalemia.
What This Means for People with High Blood Pressure
This study offers hope for individuals with uncontrolled and treatment-resistant high blood pressure. Lorundrostat, a new drug that targets a hormone called aldosterone, has shown promise in effectively lowering blood pressure, even in people already taking multiple medications.
However, it is important to note that the study also highlighted a risk of increased potassium levels, a condition that needs to be carefully monitored by healthcare professionals.
The researchers believe that lorundrostat could be a valuable new option for treating resistant hypertension if future studies confirm these positive results. For now, it’s a promising development in the ongoing effort to help people manage their blood pressure and live healthier lives.
