Aldosterone Dysregulation: Looking Beyond the Cornerstone in Hypertension
Prof David Wheeler introduces the session and presents a case of resistant hypertension in a patient with T2DM and renal impairment. With the panel he discusses treatment options and explore the next best step in managing this case.
Explore the on-demand version of this expert-led symposium, originally presented at ERA 2025, focusing on the latest advances in managing resistant hypertension and aldosterone dysregulation. Led by Prof David Wheeler and an expert faculty panel, the session covers real-world case studies, pathophysiology, emerging therapies such as ASIs and insights from landmark trials like AIMHY and PATHWAY-2. The symposium also highlights the move toward personalised hypertension management and offers practical guidance on integrating new approaches into clinical practice. The programme includes interactive discussions, audience Q&A and key take-home messages, offering practical perspectives on managing complex cases of hypertension and CKD.
Learning Objectives
- Describe the role of aldosterone dysregulation in uncontrolled hypertension and CKD
- Identify individuals who may benefit from early, direct aldosterone inhibition
- Recall emerging therapeutic options that directly target aldosterone synthesis
- Recall examples of how understanding patient phenotype and genotype may determine effective hypertension management
Target Audience
- Cardiologists
- Hypertension Specialists
- Nephrologists
- Allied HCPs
More from this programme
Part 1
Prof David Wheeler introduces the session and presents a case of resistant hypertension in a patient with T2DM. With the panel he discusses treatment options and explore the next best step in managing this case.
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Part 2
Dr Sophia Ambruso presents an overview of aldosterone dysregulation in hypertension and CKD. The session explores its physiological and pathophysiological roles, impact on cardiorenal disease, causes like high salt intake and aldosterone breakthrough and its prevalence. Gain insights into how aldosterone contributes to disease progression and treatment challenges.
Part 3
Prof Paolo Mulatero explores therapeutic approaches to aldosterone dysregulation, focusing on aldosterone synthase inhibitors (ASIs). The talk covers ASI mechanism of action, benefits over MRAs and key Phase 2/3 trial data in hypertension and CKD.
Part 4
Prof Ian Wilkinson discusses the shift toward personalised hypertension management, highlighting insights from nephrology studies like AIMHY and PATHWAY-2, which reveal the importance of genetics and the high-aldosterone phenotype spectrum. ARR testing guidelines are reviewed, followed by a faculty Q&A on adapting clinical practice to support a more tailored approach.
Part 5
The symposium concludes with an interactive audience Q&A and panel discussion. A dynamic exchange that reinforces clinical insights and practical applications. Prof David Wheeler, summarises key take-home messages from the session.
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Faculty Biographies
David Wheeler
Professor of Kidney Medicine
David Wheeler is Professor of Kidney Medicine at University College London and Honorary Consultant Nephrologist at the Royal Free London NHS Foundation Trust.
Prof Wheeler is a clinician scientist interested in the complications of chronic kidney disease (CKD), specifically those that increase the burden of cardiovascular disease and/or accelerate progression of kidney failure. He has participated in the development and running of several large-scale clinical trials testing lipid-lowering regimens, calcimimetics, intravenous iron, sodium–glucose co-transporter 2 inhibitors and hypoxia-inducible factor stabilisers in patients with CKD.
Prof Wheeler has also been involved in the development of clinical practice guidelines for several organisations, most recently for Kidney Disease: Improving Global Outcomes (KDIGO). He served as KDIGO co-Chair between 2012 and 2019. His ongoing roles include serving as the National Specialty Lead for the…
Sophia Ambruso
Clinical Nephrologist and Assistant Professor
Dr Sophia Ambruso is a Clinical Nephrologist and Assistant Professor at the Rocky Mountain VA Medical Center and University of Colorado School of Medicine, Denver, US. Dr Ambruso is passionate about patient care and medical education. She is on the Executive Committee and a faculty member for the Nephrology Social Media Collective (NSMC) internship.
Paolo Mulatero
Professor of Internal Medicine and Head of the Hypertension Unit
Prof Paolo Mulatero is Professor of Internal Medicine and Head of the Hypertension Unit, Department of Medical Sciences at the University of Turin, Turin, Italy. His main research interests include pathophysiology; clinical and molecular genetics of primary aldosteronism; biochemistry and genetics of 11b-hydroxylase and aldosterone synthase (CYP11B1 and CYP11B2) and their role in human pathologies (essential hypertension, primary aldosteronism, glucocorticoid-remediable aldosteronism, aldosterone synthase deficiency type I and II); clinical genetics of the monogenic forms of hypertension; the genetic and pathophysiology of essential and secondary hypertension and the evaluation of the cardiovascular risk factors.
Ian Wilkinson
President of the British and Irish Hypertension Society and Professor of Therapeutics
Prof Ian Wilkinson is President of the British and Irish Hypertension Society and leads the Division of Experimental Medicine and Immunotherapeutics at the University of Cambridge. He has over 25 years of research experience in hypertension, leading national trials including AIMHY Trial and POPPY Study. He directs the Cambridge Clinical Trials Unit and provides specialist hypertension services, including care for hypertensive disorders in pregnancy. Prof Ian Wilkinson advises NHSE and the Cardiovascular Prevention Leadership Group and supports national guidelines and public health campaigns. He also teaches pharmacology and physiology at the University of Cambridge and serves as a non-executive director at Royal Papworth Hospital.
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