A new investigational drug called lorundrostat has demonstrated the ability to lower blood pressure in patients with chronic kidney disease (CKD) who remain uncontrolled despite taking multiple medications. The findings, presented at the European Meeting on Hypertension and Cardiovascular Protection in Poland on May 30, 2026, offer hope for a population with few effective options.

Why Is Blood Pressure Control So Difficult in Kidney Disease?

Managing high blood pressure becomes significantly more challenging when kidney disease is present. Up to 75% of patients with CKD still have uncontrolled or resistant blood pressure despite available treatments, according to Mineralys Therapeutics, the company developing lorundrostat. This matters because uncontrolled blood pressure accelerates kidney damage and dramatically increases the risk of heart attack and stroke in this already vulnerable population.

The relationship between kidney disease and high blood pressure is bidirectional: sustained high blood pressure damages the kidneys, and progressive kidney damage makes blood pressure harder to control. When both conditions coexist, the risk of cardiovascular disease and death rises substantially. Researchers have identified dysregulated aldosterone, a hormone that controls sodium and fluid balance, as a key driver of this difficult-to-treat combination.

What Did the Clinical Trial Show?

The Phase 3 Launch-HTN trial enrolled 800 participants with uncontrolled or resistant high blood pressure. Among these, 192 participants had chronic kidney disease. The study was particularly rigorous because it focused on patients already taking multiple blood pressure medications: 71% of those with kidney disease were on three or more antihypertensive drugs at baseline, compared with 56% of those without kidney disease.

Lorundrostat demonstrated significant blood pressure reductions in both groups. Among kidney disease patients, the drug achieved a placebo-adjusted reduction in systolic blood pressure (the top number) of 9.6 millimeters of mercury (mmHg) at 12 weeks, compared with 12.2 mmHg in patients without kidney disease. More importantly, 44% of kidney disease patients taking lorundrostat reached the target blood pressure of less than 130 mmHg, compared with only 18% in the placebo group.

The drug also showed a remarkable effect on albuminuria, a marker of kidney damage. Among 84 kidney disease patients with elevated baseline albumin in their urine, lorundrostat achieved a 52.2% placebo-adjusted reduction in the albumin-to-creatinine ratio at 12 weeks, a statistically significant difference. This is particularly important because reducing albuminuria is associated with slowing kidney disease progression.

How Does Lorundrostat Work?

Lorundrostat is a selective aldosterone synthase inhibitor, meaning it blocks the enzyme responsible for producing aldosterone. By reducing aldosterone levels, the drug addresses a root cause of both difficult-to-treat high blood pressure and kidney injury. Excess aldosterone promotes sodium retention, vascular inflammation, and fibrosis, all of which contribute to worsening blood pressure control and kidney damage.

Steps to Understanding This Treatment Approach

• Mechanism of Action: Lorundrostat works by inhibiting CYP11B2, the enzyme that produces aldosterone, thereby reducing the hormone's effects on sodium retention and vascular inflammation.
• Target Population: The drug is designed for patients with uncontrolled or resistant hypertension, particularly those with comorbidities such as chronic kidney disease, obstructive sleep apnea, and other conditions driven by dysregulated aldosterone.
• Safety Profile: In the trial, lorundrostat demonstrated a favorable safety profile with low rates of hyperkalemia (elevated potassium), a potential concern with aldosterone-blocking drugs, occurring in only 2.4% of kidney disease patients and 0% of those without kidney disease.

"These findings are compelling because they show that lorundrostat achieves comparable blood pressure reductions regardless of kidney disease status, while also significantly reducing albuminuria, a key marker of kidney injury and disease progression, in these patients," stated Dr. Liffert Vogt, Professor of Nephrology and Renal Transplantation at Amsterdam University Medical Center and University of Amsterdam.

Dr. Liffert Vogt, Professor of Nephrology and Renal Transplantation at Amsterdam University Medical Center and University of Amsterdam

What Is the Current Status of This Drug?

Lorundrostat is currently under review by the U.S. Food and Drug Administration (FDA), with a target decision date of December 22, 2026. The company has also presented data from a separate trial called Explore-CKD, which showed similar benefits when lorundrostat was added to standard kidney disease care. These complementary findings strengthen the evidence base for the drug's potential role in treating this high-risk population.

The broader context is important: dysregulated aldosterone is believed to drive hypertension in approximately 30% of all hypertensive patients, suggesting that aldosterone-targeting drugs like lorundrostat could benefit a substantial portion of the population struggling with blood pressure control.

Why Should Kidney Disease Patients Care About This?

For the millions of people living with chronic kidney disease, uncontrolled blood pressure is a major threat to long-term health. Without effective management, CKD can progress to kidney failure, requiring dialysis or transplantation. A medication that addresses both the blood pressure problem and the underlying aldosterone dysregulation could slow disease progression and reduce the risk of heart disease and stroke. The fact that lorundrostat showed benefits even in patients already taking multiple blood pressure medications suggests it could help those who have exhausted current treatment options.