BaxHTN Trial – Baxdrostat in Resistant/Uncontrolled Hypertension
BaxHTN Trial – Baxdrostat in Resistant/Uncontrolled Hypertension
Source: Medical News | ESC 2025 | August 31, 2025
1. Background
• Baxdrostat: first-in-class aldosterone synthase inhibitor.
• Targets overproduction of aldosterone → key driver of resistant/uncontrolled hypertension.
2. Design
• Phase 3 RCT, 794 patients with resistant (73%) or uncontrolled (27%) hypertension.
• Already on ≥3 antihypertensives (99% diuretic, 90% ACEi/ARB).
• Randomized to baxdrostat (1 mg or 2 mg daily) vs placebo for 12 weeks.
3. Results
• Office SBP reduction (placebo-corrected):
• –8.7 mmHg (1 mg)
• –9.8 mmHg (2 mg)
• 24h Ambulatory SBP reduction: ≈ –15 mmHg.
• Nighttime SBP reduction: –12 mmHg.
• Effect persisted after withdrawal phase (minimal rebound).
4. Safety
• Generally well tolerated.
• Hyperkalemia risk:
• K⁺ >6 mmol/L in 2.3–3%.
• Required intervention in 2.7% (1 mg) and 7.9% (2 mg).
• Monitoring of potassium recommended at initiation.
5. Interpretation
• Baxdrostat shows robust BP lowering on top of intensive therapy.
• Durable effect suggests potential to reset disease mechanisms (aldosterone-driven sodium retention, vascular stiffening).
• Experts called it a “game changer” for resistant hypertension.
6. Funding
• Trial funded by AstraZeneca.
