Continuing an annual series covering key developments in cardiovascular pharmacotherapy, the 2024 review by Tamargo et al. has now been published in the European Heart Journal – Cardiovascular Pharmacotherapy. 2024 reflected a year of continued momentum in the field, marked by the emergence of first-in-class agents, label expansions for established drugs, and the publication of several key clinical trials.

Among the notable approvals highlighted are aprocitentan, a dual endothelin-A and -B receptor antagonist for resistant hypertension, and sotatercept, a novel fusion protein for pulmonary arterial hypertension (PAH). These agents address areas of persistent unmet clinical need, with mechanisms that depart from traditional pathways. Additionally, the introduction of a fixed-dose macitentan–tadalafil combination for PAH may enhance treatment adherence by simplifying multi-drug regimens.

The review also emphasises the how use of established drugs developed, such as semaglutide and bempedoic acid, both of which saw label expansions supported by cardiovascular outcome data. Particularly notable is semaglutide’s broader application in patients with diabetes and chronic kidney disease, and its emerging cardiovascular benefits in high-risk populations.

The authors classify trials into positive, neutral, and safety-focused categories, helping to guide readers through the wealth of new data that became available during the year. Studies such as BROAD, ARTESIA, and SELECT further informed on the benefits of intensive cardiovascular risk factor modification, while others such as CLEAR Outcomes and ATTRibute-CM refined our understanding of therapy-specific effects in selected populations.

Importantly, the review includes a section dedicated to drug safety, emphasising the clinical relevance of adverse event profiles and drug–drug interactions. These considerations are increasingly recognised as central to real-world effectiveness, especially in the context of concerns around polypharmacy.

This annual summary in general reflects an ongoing path in cardiovascular pharmacotherapy towards more targeted, mechanism-driven interventions, supported by high-quality evidence. It also highlights the importance of multidisciplinary collaboration in advancing both clinical innovation and patient-centred outcomes.