The guidelines recommend mineralocorticoid receptor antagonists (MRAs) as a fourth-line treatment for TRH.2 This is based on trial data showing that spironolactone vs alternative treatments significantly lowered BP,11 especially in patients with a biochemical profile indicative of more enhanced aldosterone.12 Therefore, non-steroidal MRAs and an aldosterone synthase inhibitor (ASI) may be promising options to target aldosterone activations for TRH and/or CKD. This evidence concerns the gene TRH and chronic kidney disease.