Queen Mary: 6–12 months of an aldosterone synthase inhibitor kept effect up to two years in 14 patients
In an observational follow-up of 14 people with primary aldosteronism, hormone levels and blood pressure stayed improved up to two years after a 6–12-month drug course ended.
Researchers led by Queen Mary University of London report that a 6–12-month course of a new class of drugs, aldosterone synthase inhibitors, was followed by sustained reversal of excess aldosterone production in people with primary aldosteronism, according to EurekAlert eurekalert.org
EurekAlerteurekalert.orgOpen source ↗. The approach is called extended aldosterone synthase inhibition (EASI). The observational study, published on 7 November 2026 in the New England Journal of Medicine, followed 14 people treated at eight centres in the United States.
Results after treatment ended
The authors found partial or complete resolution of high blood pressure for up to two years after treatment stopped. Hormone levels and blood pressure remained similar to, or lower than, those recorded during EASI treatment. The main marker of excess aldosterone production stayed 99 per cent lower than before treatment, and blood pressure was on average 25 points lower. Almost a quarter of participants had normal blood pressure without any other medication.
Earlier larger studies of aldosterone synthase inhibitors in hypertension generally used treatment periods of 6–12 weeks and measured outcomes during treatment. Until now, cure of primary aldosteronism has required surgery to remove an entire adrenal gland. Lead author Morris Brown said the authors are cautious because of the pragmatic nature of the study, and that EASI is unlikely to be the answer for most patients with hypertension.
Background and next trial
It is estimated that 5–10 per cent of high blood pressure cases are caused by primary aldosteronism, in which benign nodules in the adrenal glands produce too much aldosterone and the kidneys retain excess salt eurekalert.org
EurekAlerteurekalert.orgOpen source ↗. The rationale dates to a 2005 mouse experiment: deleting the gene for aldosterone synthase made the aldosterone-producing cells disappear. The Queen Mary team predicted that prolonged inhibition might have a similar effect in humans.
The analysis used routine follow-up measurements of blood pressure and hormone levels from the first study of this drug class in people with primary aldosteronism, reported last year in the same journal, and compared them with values before treatment. Mason Freeman of Harvard Medical School, who initiated the original study, called the sustained remission of biochemical markers an unexpected finding.
The researchers are now leading a larger prospective clinical trial, ELIXIR, to test whether EASI can provide a lasting cure. It will also use molecular imaging of the adrenal glands to check whether prolonged treatment makes aldosterone-producing cells disappear.
