How Would Waiting List Expansion Affect Transplant Wait Times?

The highly specific aldosterone synthase inhibitor lorundrostat lowers blood pressure (BP) in patients with uncontrolled, treatment-resistant hypertension, reports a clinical trial in The New England Journal of Medicine.The multicenter phase 2b trial targeted patients with uncontrolled hypertension, defined as an office BP measurement of 140/90 mm Hg or higher despite treatment with two to five antihypertensive medications.Eligible patients received a standardized 3-week antihypertensive regimen.Those with an average 24-hour ambulatory BP of 130/80 mm Hg or higher were randomly assigned to receive placebo; stable-dose lorundrostat, 50 mg/day; or adjustable-dose lorundrostat, with dosage increased to 100 mg/day if systolic BP remained at 130 mm Hg or higher after 4 weeks.Change in 24-hour average systolic BP was assessed in a double-blind fashion after 12 weeks of treatment, with adjustment for placebo.Secondary outcomes included a placebo-adjusted change in 24-hour systolic BP at 4 weeks in the combined lorundrostat groups.In the study, there were 285 patients who were randomized.Among the patients, the mean age was 60 years, 60% were male, and 53% were Black.Lorundrostat produced greater least-squares mean reductions in 24hour systolic BP: -15.4 mm Hg in the stable-dose group and -13.9 mm Hg in the adjustable-dose group compared with -7.4 mm Hg with placebo.With adjustment for placebo, BP reductions were -7.9 mm Hg with stable-dose and -6.5 mm Hg with adjustable-dose lorundrostat.For the combined lorundrostat groups, placebo-adjusted change in 24-hour average systolic BP was -5.3 mm Hg at 4 weeks.At that time, systolic BP was under 125 mm Hg in 41% of patients treated with lorundrostat compared with 18% with placebo (odds ratio, 3.3).On safety analysis, 5% of patients in the stable-dose lorundrostat group and 7% in the adjustable-dose group had potassium levels greater than 6.0 mmol/L compared with none in the placebo group.The new trial shows greater reductions in BP with lorundrostat versus placebo in patients with uncontrolled hypertension.The ongoing, phase 3 Launch-HTN trial (NCT06153693) will evaluate lorundrostat's effects on kidney function [Laffin LJ, et al.; Advance-HTN Investigators.Lorundrostat efficacy and safety in patients with uncontrolled hypertension.