-
Baxdrostat, a once-daily pill, significantly lowered blood pressure in patients whose hypertension had resisted existing therapies.
-
In the BaxHTN phase 3 trial, systolic blood pressure dropped by nearly 10 mmHg compared with placebo.
-
About 40% of patients achieved healthy blood pressure levels on baxdrostat versus 19% on placebo.
-
The treatment works by blocking aldosterone production, a mechanism researchers have been pursuing unsuccessfully for decades.
-
Findings were presented at the European Society of Cardiology (ESC) Congress 2025 in Madrid and published in the New England Journal of Medicine.
Why Resistant Hypertension Matters
Hypertension affects more than 1.3 billion people globally. Despite a wide range of available medications—diuretics, ACE inhibitors, ARBs, calcium channel blockers, and beta blockers—nearly half of patients worldwide fail to achieve controlled blood pressure.
Uncontrolled hypertension leads to:
-
Increased risk of heart attack and stroke
-
Progression of chronic kidney disease
-
Higher rates of heart failure
-
Premature death
Resistant hypertension, where blood pressure remains elevated despite at least three different medications, represents one of the biggest challenges in cardiology.
Baxdrostat: A New Approach
For decades, scientists have suspected that aldosterone, a hormone produced by the adrenal glands, plays a central role in stubbornly high blood pressure. Aldosterone regulates salt and water retention; when overproduced, it locks the body into a cycle of volume overload and vascular stress.
Until now, drugs could only block aldosterone’s action, not reduce its production. Baxdrostat changes that.
How It Works
-
Mechanism: Selective aldosterone synthase inhibitor
-
Effect: Reduces circulating aldosterone levels
-
Result: Less salt and water retention, lower blood pressure
“This drug development is really a triumph of scientific discovery,” said Prof. Bryan Williams, chair of medicine at UCL and lead investigator of the trial. “Baxdrostat is one of the first therapies to selectively suppress aldosterone production, and the blood pressure reductions we’re seeing are substantial.”
The BaxHTN Trial
-
Design: Double-blind, randomized, placebo-controlled phase 3 trial
-
Participants: 796 adults with uncontrolled or resistant hypertension
-
Sites: 214 clinics worldwide
-
Duration: 12 weeks
-
Sponsor: AstraZeneca
Results
-
Systolic blood pressure reduction:
-
Baxdrostat (1mg or 2mg): –9 to –10 mmHg greater than placebo
-
Placebo: minimal change
-
-
Proportion achieving healthy BP (<140/90 mmHg):
-
Baxdrostat 1mg: 39.4%
-
Baxdrostat 2mg: 40.0%
-
Placebo: 18.7%
-
Safety
Side-effect rates were similar between baxdrostat and placebo, suggesting good tolerability.
Prof. Williams noted:
“A reduction of nearly 10 mmHg in systolic blood pressure is linked to meaningfully lower risk of heart attack, stroke, and kidney failure. I think this could be a gamechanger for up to half a billion people globally.”
Global Impact
The trial results are significant given the geography of hypertension:
-
Asia accounts for over half of global cases:
-
China: 226 million people with hypertension
-
India: 199 million
-
-
Lower- and middle-income countries now face the steepest rises due to dietary changes and urban lifestyles.
-
Wealthier Western countries still carry high prevalence, but treatment access is broader.
A drug that works reliably across sex, race, and ethnicity, as BaxHTN demonstrated, could reshape global blood pressure care.
Expert Reactions
Prof. Paul Leeson, Oxford University
Independent cardiologist not involved in the trial:
“For many years, we have had medications that block aldosterone’s effects but do not actually lower levels of the hormone. Baxdrostat reduces aldosterone itself, which is a more direct approach. Importantly, the trial included diverse populations, making the findings more broadly applicable.”
ESC Congress Commentary
Physicians described baxdrostat as “a valuable additional treatment” and a potential standard of care for resistant hypertension if long-term benefits hold.
Beyond Blood Pressure: The Broader Cardiovascular Frontier
The ESC Congress also highlighted other drug innovations:
-
Inclisiran (Leqvio): A cholesterol-lowering injection given twice a year. Trial data showed patients reached cholesterol goals faster and with fewer statin-related side effects like muscle pain.
-
Together with baxdrostat, these advances suggest a new era of cardiovascular prevention therapies that target underlying pathways more precisely than older drugs.
While results are promising, several questions remain:
-
Long-term outcomes: Will baxdrostat reduce actual heart attack and stroke rates, not just blood pressure?
-
Durability: Can reductions be maintained beyond 12 weeks?
-
Cost and access: Will the drug be affordable in regions where hypertension burden is highest?
Regulatory submissions are expected in late 2025, with potential approval in 2026.
FAQs: Baxdrostat and Resistant Hypertension
What is baxdrostat?
A new drug that lowers blood pressure by directly blocking aldosterone production.
Who is it for?
Patients with uncontrolled or resistant hypertension despite taking multiple medications.
How effective is it?
In trials, baxdrostat reduced systolic blood pressure by ~10 mmHg more than placebo. About 40% of patients reached target levels.
Is it safe?
Early data show baxdrostat was well tolerated with a side-effect profile similar to placebo.
When will it be available?
If approved by regulators, baxdrostat could reach patients as early as 2026.
How is it different from existing drugs?
Unlike drugs that block aldosterone’s action, baxdrostat reduces aldosterone levels themselves, tackling the root driver.
The arrival of baxdrostat marks one of the most exciting moments in hypertension treatment in decades. By directly targeting aldosterone dysregulation, a pathway long suspected but never successfully controlled, the drug has delivered real-world blood pressure reductions in patients who previously had few options left.
If longer-term studies confirm these results, baxdrostat could become a first-in-class therapy that transforms care for millions of people worldwide, reducing not only blood pressure but the cascade of strokes, heart attacks, and kidney failures that follow.
For now, cardiologists are calling it what patients with resistant hypertension have been waiting to hear: a gamechanger.
