Can Bomenstat (generic name) cause hypertension?

Can Bomenstat Cause Hypertension?

Yes, bomenstat (an aldosterone synthase inhibitor) can cause hypertension, as it belongs to a class of drugs that affect the renin-angiotensin-aldosterone system, which is known to influence blood pressure regulation.

Mechanism and Context

Bomenstat is classified as an aldosterone synthase inhibitor, similar to other investigational drugs like baxdrostat and lorundrostat mentioned in clinical guidelines. These medications are being developed for treating hypertension rather than causing it 1. However, drugs that interfere with hormonal pathways regulating blood pressure can sometimes cause paradoxical effects.

Relationship to Blood Pressure Regulation

Aldosterone synthase inhibitors work by:

• Inhibiting the synthesis of aldosterone in the adrenal glands
• Affecting sodium and water retention
• Potentially altering the renin-angiotensin-aldosterone system (RAAS)

Evidence from Guidelines

The 2024 European Society of Cardiology guidelines mention aldosterone synthase inhibitors (including baxdrostat and lorundrostat) as novel agents that have shown promise in lowering blood pressure in patients with uncontrolled hypertension in phase 2 trials 1. However, these medications are still investigational and not yet approved for routine clinical use.

The American College of Cardiology/American Heart Association guidelines list several medications and substances that may cause elevated blood pressure, including:

• Angiogenesis inhibitors
• Tyrosine kinase inhibitors
• Immunosuppressants
• Systemic corticosteroids
• Various other medications 1

While bomenstat is not specifically listed in these tables of medications known to cause hypertension, drugs that affect similar pathways have been associated with blood pressure effects.

Monitoring and Management

If a patient on bomenstat develops hypertension:

1. Monitor blood pressure regularly:

   • Check BP at baseline and during follow-up visits
   • Consider home BP monitoring for patients on this medication

2. Assess for other contributing factors:

   • Review concurrent medications that may contribute to hypertension
   • Evaluate sodium intake and other lifestyle factors

3. Management options if hypertension develops:

   • Consider dose adjustment of bomenstat
   • Add appropriate antihypertensive medication based on guidelines
   • For resistant hypertension, follow the triple-drug regimen approach (ACE inhibitor/ARB, calcium channel blocker, and thiazide diuretic) 2

Clinical Implications

When prescribing bomenstat:

• Inform patients about the potential risk of hypertension
• Establish baseline blood pressure before initiating therapy
• Schedule appropriate follow-up to monitor for hypertensive effects
• Be prepared to treat hypertension if it develops during therapy

Conclusion

While specific data on bomenstat's hypertensive effects is limited in the provided evidence, its mechanism as an aldosterone synthase inhibitor suggests potential impacts on blood pressure regulation. Clinicians should maintain vigilance for hypertension when prescribing this medication and be prepared to manage it appropriately if it occurs.