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Guidelines recommend steroidal MRAs in patients with heart failure with reduced or mildly reduced ejection fraction, as they reduce morbidity and mortality. In heart failure with preserved ejection fraction, MRAs have not convincingly shown to improve prognosis. Steroidal MRAs delay the progression of chronic kidney disease, reduce proteinuria and lower blood pressure in resistant hypertension but can induce hyperkalaemia. Due to their limited selectivity to the mineralocorticoid receptor, steroidal MRAs can cause significant adverse effects, i.e. libido loss, erectile dysfunction, gynaecomastia, and amenorrhoea, leading to low rates of persistance. Against this background, new avenues for developing non-steroidal, selective (ns)MRAs and aldosterone-synthase inhibitors have been taken. Finerenone has been shown to delay the progression of diabetic nephropathy and lower the incidence of heart failure hospitalizations in patients with chronic kidney disease and diabetes compared with placebo. Finerenone has therefore been recommended by the 2023 European Society of Cardiology Guidelines for the management of diabetes in patients with type 2 diabetes and chronic kidney disease. Further randomized controlled trials assessing the safety and effectiveness of finerenone in patients with heart failure are currently ongoing. Esaxerenone provides antihypertensive effects and has been approved for the treatment of hypertension in Japan. Baxdrostat and lorundostat, novel selective aldosterone-synthase inhibitors, are currently under investigation. In phase II trials, baxdrostat and lorundostat were safe and effective in lowering blood pressure in resistant hypertension. In this review, we summarize and critically discuss the evidence for new drugs mitigating aldosterone in heart failure, hypertension, and chronic kidney disease.<\/jats:p>","DOI":"10.1093\/ehjcvp\/pvae049","type":"journal-article","created":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T23:39:40Z","timestamp":1720654780000},"page":"557-565","source":"Crossref","is-referenced-by-count":18,"title":["New ways of mitigating aldosterone in cardiorenal disease"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0393-3060","authenticated-orcid":false,"given":"Felix","family":"G\u00f6tzinger","sequence":"first","affiliation":[{"name":"Department of Internal Medicine III\u2014Cardiology, Angiology and Intensive Care Medicine, Homburg University Hospital, Saarland University , Kirrberger Str. 100, Homburg 66424 ,","place":["Germany"]},{"name":"Department of Cardiology, University Heart Center Basel, University Hospital Basel , Am Petersgraben 4, Basel 4031 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,","place":["Germany"]},{"name":"Department of Cardiology, University Heart Center Basel, University Hospital Basel , Am Petersgraben 4, Basel 4031 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2976-2514","authenticated-orcid":false,"given":"Michael","family":"B\u00f6hm","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III\u2014Cardiology, Angiology and Intensive Care Medicine, Homburg University Hospital, Saarland University , Kirrberger Str. 100, Homburg 66424 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4425-549X","authenticated-orcid":false,"given":"Felix","family":"Mahfoud","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III\u2014Cardiology, Angiology and Intensive Care Medicine, Homburg University Hospital, Saarland University , Kirrberger Str. 100, Homburg 66424 ,","place":["Germany"]},{"name":"Department of Cardiology, University Heart Center Basel, University Hospital Basel , Am Petersgraben 4, Basel 4031 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,7,10]]},"reference":[{"key":"2024100407354028800_bib1","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1161\/HYPERTENSIONAHA.114.04488","article-title":"Mineralocorticoid receptor activation and mineralocorticoid receptor antagonist treatment in cardiac and renal diseases","volume":"65","author":"Bauersachs","year":"2015","journal-title":"Hypertension"},{"key":"2024100407354028800_bib2","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/nrcardio.2016.163","article-title":"Neurohormonal activation in heart failure with reduced ejection fraction","volume":"14","author":"Hartupee","year":"2017","journal-title":"Nat Rev 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