A recent clinical trial featured in the New England Journal of Medicine showcased a promising drug, baxdrostat, aimed at people suffering from resistant hypertension—high blood pressure that remains high despite standard treatment. Resistant hypertension is a widespread issue, affecting around 1.3 billion people globally, with a huge percentage not receiving effective treatment. The drug belongs to a new class of aldosterone synthase inhibitors and could provide an alternative treatment for patients who haven’t responded to existing medications, enhancing the options available for managing this critical health issue.
Baxdrostat specifically addresses high blood pressure often associated with excessive levels of aldosterone—a hormone responsible for regulating salt and water balance in the body. The trial demonstrated that the drug effectively lowers aldosterone levels, avoiding the common side effects linked with other existing hypertension treatments, such as spironolactone. Participants in the trial showed a significant reduction in blood pressure readings, with those taking baxdrostat experiencing an average decrease of 9-10 mm Hg in seated systolic pressure compared to those on a placebo.
The study included nearly 800 patients, whose average blood pressure at the start was 149/87 mm Hg. As the trial proceeded, approximately 40% of the patients taking baxdrostat achieved healthy systolic blood pressure levels under 130 mm Hg, compared to just 19% of placebo recipients. The effectiveness of baxdrostat was consistent across diverse demographics, including patients taking multiple blood pressure medications, indicating its broad applicability in treating resistant hypertension.
Healthcare professionals noted the importance of these results, primarily because baxdrostat managed to deliver significant blood pressure reductions without the undesirable side effects that often accompany traditional treatments. Mild increases in potassium levels were observed, but these were far less pronounced than those typically seen with spironolactone. The drug’s kidney effects appeared minor, potentially even beneficial, reducing harmful hyperfiltration, a common issue in patients with high blood pressure.
The trial also involved an eight-week withdrawal phase, during which a rise in systolic pressure was noted in patients who stopped taking baxdrostat, while those who continued benefitted from further reductions. This prolonged response to treatment was highlighted as a unique attribute that could improve adherence to medication regimens, crucial for long-term management of hypertension and associated cardiovascular risks, including heart attack and stroke.
Despite the exciting potential of baxdrostat, experts emphasize the need for further research to ascertain its position in hypertension treatment protocols. AstraZeneca plans to seek U.S. regulatory approval by late 2025, but its use should still coincide with lifestyle modifications and ongoing medical supervision to effectively reduce cardiovascular risks. The integration of baxdrostat into treatment plans could significantly aid high-risk individuals in achieving optimal blood pressure targets, thereby improving overall cardiovascular health outcomes.
