Core Viewpoint - The release of the 2025 ACC/AHA hypertension clinical guidelines indicates a new direction for hypertension prevention and treatment, highlighting the need for innovative solutions like renal denervation (RDN) to address the global challenge of uncontrolled hypertension [1]. Group 1: Differences Between US and China Guidelines - The US guidelines emphasize early intervention and precise stratification, setting the hypertension threshold at 130/80 mmHg to promote proactive management [2]. - The control targets in the US guidelines recommend a universal goal of <130/80 mmHg, with further specifications for high cardiovascular risk patients to lower systolic pressure to <130 mmHg, ideally <120 mmHg [3]. - In contrast, the Chinese guidelines set the hypertension threshold at 140/90 mmHg, aligning with local epidemiological characteristics and focusing on practical clinical management [4][5]. Group 2: RDN Clinical Application Under Guidelines - The 2025 US hypertension guidelines outline a comprehensive process for RDN application, emphasizing "precise selection, collaborative decision-making, and long-term management" [6]. - RDN is primarily indicated for patients with resistant hypertension, specifically those requiring three or more antihypertensive medications without achieving control [7]. - A multidisciplinary team (MDT) is essential for evaluating patients for RDN, ensuring thorough screening for secondary hypertension and contraindications [9]. Group 3: RDN as a New Treatment Option - RDN is recognized as a valuable adjunct treatment for resistant hypertension, with a recommendation level of 2b, B-R in the 2025 guidelines, indicating its use under specific conditions [11]. - The Iberis RDN system demonstrates significant efficacy, with a study showing a 13 mmHg reduction in 24-hour ambulatory systolic blood pressure and a 21 mmHg reduction in office systolic blood pressure at six months post-treatment [13]. - RDN offers a continuous blood pressure-lowering effect, providing a promising solution for patients with difficult-to-treat hypertension [13][14].

Core Viewpoint - The American Heart Association and the American College of Cardiology have released a new hypertension clinical practice guideline, marking the first update since 2017, which emphasizes early intervention and treatment for borderline hypertension [1][2]. Summary by Relevant Sections Hypertension Guidelines - The new guideline maintains the target blood pressure values for adults: normal blood pressure is below 120/80 mmHg, and elevated blood pressure ranges from 120-129/80 mmHg. Action is required if blood pressure is 130/80 mmHg or higher [1]. - For systolic blood pressure between 130 and 139 mmHg, lifestyle changes should be the first step. If blood pressure does not reach the target range after 3 to 6 months, medication is recommended, differing from the previous guideline which suggested medication for systolic pressure above 140 mmHg [1]. Lifestyle Adjustments - Recommended lifestyle adjustments include maintaining a healthy weight, following a heart-healthy diet, reducing sodium intake, managing stress, engaging in moderate physical activity, and limiting or abstaining from alcohol [1][2]. - The new guideline advises minimizing alcohol consumption, with the ideal choice being complete abstinence, contrasting with the previous recommendation of limited daily alcohol intake [2]. Dietary Recommendations - The dietary recommendations remain consistent, emphasizing increased consumption of fruits, vegetables, whole grains, and low-fat dairy while reducing saturated fat and total fat intake. Sodium intake should be less than 2,300 mg per day, with an ideal target of 1,500 mg [2]. - For overweight or obese individuals, a weight loss of at least 5% is recommended, with clinically proven interventions suggested for those with severe obesity [2]. Publication - The new guidelines have been published in the Journal of the American College of Cardiology [3].

Misconceptions about Hypertension Treatment - Misconception 1: No symptoms means no medication is needed. Early-stage hypertension often shows no symptoms, but untreated high blood pressure can severely damage organs like the heart, brain, and kidneys, necessitating active intervention once diagnosed [1] - Misconception 2: Normal blood pressure allows for stopping medication. Hypertension is a chronic condition requiring long-term medication to control blood pressure, as stopping can lead to rebound hypertension and increased risk of complications like myocardial infarction and stroke [3] - Misconception 3: Antihypertensive drugs are addictive. Antihypertensive medications are non-addictive, and while they may be temporarily stopped in cases of stress-induced hypertension, diagnosed patients must adhere to their medication regimen to prevent blood pressure from rising again [4] - Misconception 4: Initial treatment should not use "good drugs." Long-acting antihypertensive medications are preferred for stable blood pressure control, while short-acting drugs are reserved for acute situations [6] - Misconception 5: High blood pressure should be rapidly normalized. Blood pressure should be lowered gradually to avoid complications like cerebral hypoperfusion, with a focus on a slow, steady, and moderate reduction [7] - Misconception 6: Single blood pressure measurement is sufficient for diagnosis. A proper diagnosis of hypertension requires multiple measurements over different days, as occasional high readings can be due to anxiety [9] - Misconception 7: Frequent changes in medication are beneficial. Finding the right antihypertensive medication can take time, and once stable, patients should continue with their regimen unless adverse effects occur [10] - Misconception 8: Self-medicating based on others' experiences is safe. Hypertension has various causes and individual responses to treatment can differ, making it essential to follow a doctor's guidance for medication [12] - Misconception 9: Health supplements can effectively lower blood pressure. Many believe in the efficacy of health supplements for blood pressure control, but these claims lack scientific validation and can delay proper treatment [13] - Misconception 10: Intravenous treatment is necessary for hypertension. Most cases of hypertension should be managed with oral medications, reserving intravenous treatment for acute hypertensive crises [14] - Misconception 11: Lower blood pressure is always better. Extremely low blood pressure can compromise organ perfusion, leading to serious conditions like cerebral thrombosis [16] - Misconception 12: Regular check-ups are unnecessary. Patients should have periodic evaluations to monitor for adverse drug reactions and assess the impact on target organs, even if blood pressure appears stable [17]

Core Insights - The innovative drug Rulitan® (generic name: Aliskiren Indapamide Sustained-release Tablets) has been launched on JD Health, marking a significant advancement in hypertension treatment in China [1][2] - Rulitan® is the first ARNI + thiazide-like diuretic fixed-dose combination antihypertensive drug developed exclusively by the company, utilizing a triple mechanism for blood pressure reduction [1] - The prevalence of hypertension among adults in China is approximately 27.5%, highlighting a substantial market opportunity for effective treatment options [1] Company Strategy - The company plans to strategically cover various segments of hypertension patients with Rulitan®, complementing its existing products such as Xintan® (Aliskiren Tablets), Xinchao® (Sacubitril Aliskiren Calcium Tablets), and Rulitan® (Aliskiren Amlodipine Tablets) [2] - The collaboration with JD Health aims to enhance the accessibility of innovative drugs, addressing clinical needs and benefiting a larger patient population [2] Market Context - Hypertension is a systemic disease that can lead to severe complications such as stroke, coronary heart disease, heart failure, and renal failure, emphasizing the importance of effective treatment options [1] - The drug is particularly suitable for patients with salt-sensitive hypertension, elderly patients, and those with comorbidities such as diabetes and metabolic syndrome [1]

Core Viewpoint - The article highlights the significant advancements in hypertension treatment with the successful clinical application of the Iberis RDN system at Hospital Universitario de Torrejón de Ardoz in Madrid, emphasizing its academic value and clinical potential in treating uncontrolled hypertension [2][5]. Group 1: Technological Innovation - The Iberis RDN system represents a breakthrough in renal denervation (RDN) procedures by utilizing the radial artery for access, which reduces trauma and recovery time compared to traditional femoral artery approaches [5]. - The system employs a unique design with a circular four-electrode ablation mechanism and a <4Fr catheter, allowing for precise adaptation to the complex anatomy of renal arteries, enhancing treatment efficacy [10]. - Integrated features such as wall contact testing, precise temperature control, and safety cut-off functions improve the accuracy and stability of the procedure [10]. Group 2: Clinical Outcomes - A case study reported a 43-year-old patient with hereditary resistant hypertension who experienced significant symptom improvement and reduced medication usage following the RDN procedure, showcasing the system's effectiveness [7]. - The rapid recovery and positive feedback from patients have been noted as redefining the recovery experience for hypertension surgeries [7]. Group 3: Future Prospects - The Iberis RDN technology is expected to benefit Spanish hypertension patients, particularly those with poor drug control or intolerance to multiple medications, providing new treatment pathways [8]. - The recognition of the technology's safety and efficacy by Spanish media supports its potential for broader application, including improvements in arrhythmia management [8]. - Ongoing multi-center clinical practices and evidence development are anticipated to further validate the technology's potential in diverse applications for hypertension treatment [8].

Core Viewpoint - The article emphasizes the long-term journey of innovation in the pharmaceutical industry, particularly in the hypertension treatment sector, highlighting the recent advancements and unmet needs in this area [3][4]. Group 1: Hypertension Overview - Hypertension affects approximately 1 billion people globally and has seen no significant breakthroughs in core treatment targets for over 40 years [4][5]. - It is a leading cause of cardiovascular diseases and overall mortality, with 10.8 million deaths attributed to high systolic blood pressure in 2019, accounting for about 20% of total deaths [6]. - The prevalence of hypertension is approximately 1.4 billion globally, with 80 million in the U.S. and 90 million in the EU, representing 31% and 24% of the adult population, respectively [6]. Group 2: Treatment Landscape - Current hypertension treatments include lifestyle changes, antihypertensive medications, and some devices [21]. - The article outlines the classification of hypertension into controlled and uncontrolled categories based on blood pressure readings and medication regimens [14]. - The recommended initial medications for hypertension treatment include ACE inhibitors, ARBs, thiazide diuretics, and calcium channel blockers [23]. Group 3: Recent Developments - The recent success of Mineralys in advancing hypertension treatment through innovative drug mechanisms has opened new possibilities in the field [4][5]. - The article discusses the concept of "aldosterone escape," where patients experience a rebound increase in aldosterone levels despite treatment, leading to resistant hypertension [36][39]. - Aldosterone synthase inhibitors (ASI) are highlighted as a promising new class of drugs that can directly inhibit aldosterone production, addressing both RAAS and non-RAAS pathways [40][42]. Group 4: Mechanisms of Hypertension - The pathophysiology of hypertension involves multiple systems, including renal, vascular, neural, and the RAAS system, with obesity also playing a significant role [26][27]. - The article explains the mechanisms by which aldosterone contributes to hypertension, including both direct and indirect pathways [29][36]. Group 5: Clinical Implications - The article emphasizes the importance of accurate blood pressure measurement techniques to avoid misdiagnosis of hypertension, such as white coat hypertension and masked hypertension [18][20]. - It also discusses the need for personalized treatment goals based on individual patient circumstances, particularly for older adults or those with multiple comorbidities [20].

Core Viewpoint - High blood pressure is a common chronic disease that poses serious health risks, and patients often mistakenly believe they can stop medication once their blood pressure appears normal, which can lead to dangerous health consequences [1][4][17] Group 1: Risks of Stopping Medication - Patients who abruptly stop taking antihypertensive medication may experience a rebound effect, leading to blood pressure spikes that can exceed pre-treatment levels, known as "rebound hypertension" [4][5] - Symptoms associated with rebound hypertension include anxiety, insomnia, facial flushing, palpitations, sweating, headaches, and nausea, which can be particularly dangerous for those with pre-existing cardiovascular conditions [4][5] - A clinical study indicated that even under professional monitoring, 14% of patients experienced discomfort during short-term medication cessation, with about 4% requiring emergency care [5] Group 2: Irregular Medication Use - Irregular medication adherence, such as taking medication sporadically, can lead to significant blood pressure fluctuations, increasing the risk of cardiovascular events [8][9] - Research shows that for every 2 mmHg increase in short-term blood pressure variability, the risk of death rises by 28%, and the risk of cardiovascular events increases by 24% [8][9] - Young adults are particularly prone to irregular medication use, often believing they can manage their condition without consistent treatment, which can lead to a significant increase in blood pressure within six months [9][15] Group 3: Conditions for Medication Reduction - Not all patients are required to remain on medication indefinitely; specific conditions must be met for potential medication reduction, including stable blood pressure over several months and low body mass index [12][15] - A study showed that older patients on multiple antihypertensive medications could safely reduce their regimen under medical supervision, with over 85% maintaining target blood pressure levels [14][15] - The decision to reduce or stop medication should be a collaborative process between the patient and healthcare provider, involving careful monitoring and assessment of risks [15][16]

Financial Data and Key Metrics Changes - The company ended the first quarter of 2025 with cash, cash equivalents, and investments of $343 million, compared to $198.2 million as of December 31, 2024, indicating a significant increase in liquidity [23] - R&D expenses for the quarter were $37.9 million, up from $30.8 million in the same quarter of 2024, primarily due to increased preclinical and clinical costs [24] - The net loss for the quarter was $42.2 million, compared to $31.5 million for the same period in 2024, reflecting higher expenses [25] Business Line Data and Key Metrics Changes - The pivotal trials for lorundrostat, including LAUNCH HTN and ADVANCE HTN, achieved statistically significant results in reducing systolic blood pressure in patients with uncontrolled and resistant hypertension [6][9] - The LAUNCH HTN trial demonstrated a placebo-adjusted reduction in systolic blood pressure of 9.1 mmHg at week six and maintained a reduction of 11.7 mmHg at week twelve [14] - The ADVANCE HTN trial showed a placebo-adjusted reduction of 7.9 mmHg in systolic blood pressure, confirming the efficacy of lorundrostat in a high-risk population [17] Market Data and Key Metrics Changes - A survey indicated that 95% of physicians are likely to prescribe lorundrostat if approved, particularly for third and fourth-line treatment of hypertension [9] - The company is targeting approximately 47,000 physicians who account for a significant portion of prescriptions for uncontrolled and resistant hypertension [49] Company Strategy and Development Direction - The company aims to submit a New Drug Application (NDA) for lorundrostat, incorporating data from multiple pivotal trials, including the ongoing EXPLORER CKD trial [9][35] - The appointment of Eric Warren as Chief Commercial Officer is part of the strategy to prepare for potential FDA approval and to enhance commercial efforts [11] - The company is exploring the use of lorundrostat in treating comorbid conditions such as obstructive sleep apnea and hypertensive nephropathy, indicating a broader strategic focus [22] Management's Comments on Operating Environment and Future Outlook - Management expressed optimism about the clinical profile of lorundrostat and its potential to address significant unmet medical needs in hypertension [9][93] - The company plans to engage with the FDA in a pre-NDA meeting in Q4 2025 to discuss the path forward for lorundrostat's approval [9] - Management highlighted the importance of the benefit-risk profile of lorundrostat, especially in populations with advanced kidney disease [28] Other Important Information - The company completed a public equity financing that raised approximately $201.2 million, strengthening its balance sheet [12] - The EXPLORER CKD trial is designed to evaluate the safety and efficacy of lorundrostat in patients with chronic kidney disease, which is a critical area of focus for the company [19] Q&A Session Summary Question: What would be the max level of grade two hyperkalemia that would be acceptable if lorundestat yields a high single-digit placebo-adjusted SBP reduction? - Management indicated that specialists are more comfortable with higher potassium levels if there is a significant benefit in blood pressure and kidney function [28] Question: Do you expect similar efficacy and safety with lorundestat as seen with other treatments? - Management anticipates clinically meaningful reductions in blood pressure based on previous studies, but specifics are too early to determine [30] Question: How does the EXPLORER CKD study fit into the strategy for regulatory submission? - The EXPLORER CKD study will be part of the NDA submission, providing clinical support for patients with lower eGFR [35] Question: What are the gating factors to finalizing and filing the NDA? - Key factors include the completion of the open-label extension study and the collection of sufficient data to support the NDA submission [53] Question: Can you discuss any early discussions with potential partners? - Management has not provided updates on partnering discussions but believes that partnerships will be part of the company's strategy moving forward [60] Question: What are the primary objectives for the EXPLORER CKD study? - The primary focus is on safety and clinically meaningful reductions in blood pressure in the CKD population [70] Question: What is the expected timeline for hypertension guidelines to include data from the LAUNCH and ADVANCE HTN studies? - Management noted that it is too early to predict when guidelines will be updated but emphasized the importance of the data for informing treatment paradigms [68]