The FDA has approved Widaplik (Azurity), a fixed-dose combination of the angiotensin receptor blocker (ARB) telmisartan, the dihydropyridine calcium channel blocker amlodipine, and the thiazide-like diuretic indapamide, for treatment of hypertension in adults. Telmisartan, amlodipine, and indapamide are also available alone and in various combinations for treatment of hypertension. Two three-drug combinations containing an ARB, amlodipine, and the thiazide diuretic hydrochlorothiazide (Exforge HCT and Tribenzor) have been available for years (see Table 1).

View the Comparison Chart: Some Drugs for HFrEF

Finerenone (Kerendia – Bayer), an oral nonsteroidal mineralocorticoid receptor antagonist (MRA), has been approved by the FDA to reduce the risk of sustained eGFR decline, end-stage renal disease, nonfatal MI, hospitalization for heart failure (HF), and cardiovascular death in adults with chronic kidney disease (CKD) associated with type 2 diabetes. It is the first nonsteroidal MRA to be approved in the US.

Recently published guidelines from the American Diabetes Association (ADA) and the Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group recommend addition of the oral nonsteroidal mineralocorticoid receptor antagonist (MRA) finerenone (Kerendia) to standard treatment in patients with type 2 diabetes and chronic kidney disease (CKD).

The FDA has approved Tarpeyo (Calliditas), a delayed-release capsule formulation of the corticosteroid budesonide, to reduce proteinuria in adults with primary immunoglobulin A nephropathy (IgAN; also called Berger's disease) who are at risk of rapid disease progression. It is the fi rst drug to be approved in the US for this indication. Oral formulations of budesonide have been available for years for treatment of inflammatory bowel disease.

View the Comparison Table: Some Parenteral Anticoagulants for VTE

The FDA has approved baxdrostat (Baxfendy – AstraZeneca), an oral aldosterone synthase inhibitor, for add-on treatment of hypertension in adults whose blood pressure is not adequately controlled on other drugs. Baxdrostat is the first aldosterone synthase inhibitor to become available in the US.

Pharmacologic management of chronic heart failure (HF) is primarily determined by the patient's left ventricular ejection fraction (LVEF) and severity of symptoms. Patients with chronic HF who have an LVEF ≤40% are considered to have heart failure with reduced ejection fraction (HFrEF) and those with an LVEF ≥50% are considered to have heart failure with preserved ejection fraction (HFpEF). Patients with an LVEF of 41-49% have heart failure with mildly reduced or mid-range ejection fraction.

American College of Cardiology/American Heart Association (ACC/AHA) guidelines for treatment of hypertension were last published in 2018. Treatment of hypertensive urgencies and emergencies is not discussed here.

The injectable glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide (Ozempic – Novo Nordisk) has been approved by the FDA to reduce the risk of sustained eGFR decline, end-stage kidney disease, and cardiovascular death in adults with type 2 diabetes and chronic kidney disease (CKD). It is the first GLP-1 receptor agonist to be approved in the US for this indication.