Offense vs Defense in Aldosterone Control

Vocabulary flashcards identifying the two primary approaches to aldosterone control in hypertension—Defense (MRAs) and Offense (Baxdrostat)—including their mechanisms and clinical outcomes.

Defense (MRAs)

A treatment approach using Mineralocorticoid Receptor Antagonists like spironolactone, eplerenone, and finerenone to block aldosterone at the receptor while it is still circulating.

Breakthrough effects

Consequences resulting from the buildup of circulating aldosterone during MRA treatment, including fibrosis, remodeling, and persistent BP elevation.

Offense (Baxdrostat)

A treatment approach that targets CYP11B2 to reduce aldosterone production at the source, preventing it from being made.

CYP11B2

The specific target of Baxdrostat used to stop the production of aldosterone.

Baxdrostat clinical efficacy

Demonstrated approximately $10\,mmHg$ placebo-adjusted SBP reduction, with about $40\%$ of patients reaching the BP goal of <130.

Aldosterone Control Analogy

MRAs block the door, whereas Baxdrostat turns off the faucet.

Benefits of Offense approach

Reduces total aldosterone exposure, lowers sodium retention, decreases remodeling, and drives stronger BP control.

Spironolactone, Eplerenone, and Finerenone

Specific drugs classified as MRAs that play defense by blocking aldosterone at the receptor.