osilodrostat and Essential-Hypertension

We describe the clinical investigation of the first generation aldosterone synthase inhibitor, LCI699, in patients with essential, uncontrolled, resistant, or secondary hypertension. LCI699 competitively reduced blood pressure at lower doses yet counterintuitive effects were observed at higher doses.. An extensive endocrine biomarker analysis was performed to better understand the pharmacological mechanism of the drug.. The interference of LCI699 in the renin-angiotensin-aldosterone system occurred with limited target selectivity, as a dose-dependent compensatory stimulation of the hypothalamic-pituitary-adrenal feedback axis was discovered. Thus, LCI699 affected two endocrine feedback loops that converged at a single point, inhibiting the 11β-hydroxylase reaction in the adrenal gland, leading to supraphysiological levels of 11-deoxycortiscosterone. The accumulation of this potent mineralocorticoid may explain the blunted blood pressure response to LCI699.. Future aldosterone synthase inhibitors may improve their target selectivity by sparing the 11β-hydroxylase reaction and preferentially inhibiting one of the two other enzymatic reactions mediated by aldosterone synthase.

Topics: Adolescent; Adrenal Glands; Adult; Aged; Aldosterone; Antihypertensive Agents; Biomarkers; Blood Pressure; Cytochrome P-450 CYP11B2; Desoxycorticosterone; Double-Blind Method; Essential Hypertension; Female; Humans; Hydrocortisone; Hyperaldosteronism; Hypertension; Hypothalamus; Imidazoles; Male; Middle Aged; Prospective Studies; Pyridines; Renin-Angiotensin System; Steroid 11-beta-Hydroxylase; Treatment Outcome; Young Adult