Baxdrostat Reduces Seated Systolic BP in Uncontrolled, Resistant Hypertension

MONDAY, Sept. 8, 2025 (HealthDay News) — The addition of baxdrostat, an aldosterone synthase inhibitor, to background therapy yields a significant reduction in seated systolic blood pressure among patients with uncontrolled or resistant hypertension, according to a study published online Aug. 30 in the New England Journal of Medicine to coincide with the European Society of Cardiology Congress 2025, held from Aug. 29 to Sept. 1 in Madrid.

John M. Flack, M.D., from Southern Illinois University in Springfield, and colleagues conducted a phase 3 randomized trial involving patients with a seated systolic blood pressure of 140 mm Hg to less than 170 mm Hg despite receipt of stable treatment with two antihypertensive medications or three or more such medications (uncontrolled hypertension and resistant hypertension, respectively). Patients with a seated systolic blood pressure of 135 mm Hg or more after a two-week placebo run-in period were randomly assigned to receive 1 mg baxdrostat, 2 mg baxdrostat, or placebo once daily for 12 weeks (264, 266, and 264 patients, respectively).

The researchers found that the change from baseline in the least-squares mean seated systolic blood pressure at 12 weeks was −14.5, −15.7, and −5.8 mm Hg with 1 mg baxdrostat, 2 mg baxdrostat, and placebo, respectively. The estimated placebo-corrected difference was −8.7 and −9.8 mm Hg with 1 mg and 2 mg baxdrostat, respectively. Overall, 2.3, 3.0, and 0.4 percent of patients receiving 1 mg baxdrostat, 2 mg baxdrostat, and placebo, respectively, had a potassium level of more than 6.0 mm/L.

“Achieving a nearly 10-mm Hg reduction in systolic blood pressure with baxdrostat in the BaxHTN phase III trial is exciting, as this level of reduction is linked to substantially lower risk of heart attack, stroke, heart failure, and kidney disease,” principal author Bryan Williams, M.D., from the University College London, said in a statement.

Several authors disclosed ties to pharmaceutical companies, including AstraZeneca, which manufactures baxdrostat and funded the study.

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