Positive results from the Phase III BaxHTN trial demonstrated that baxdrostat, a potential first-in-class aldosterone synthase inhibitor, significantly and meaningfully reduced systolic blood pressure (SBP) in patients with hard-to-control hypertension, despite treatment with multiple standard therapies.

At week 12, patients receiving baxdrostat 2mg achieved a 15.7 mmHg reduction in SBP from baseline, representing a 9.8 mmHg placebo-adjusted decrease (p<0.001). The 1mg dose lowered SBP by 14.5 mmHg (8.7 mmHg placebo-adjusted; p<0.001). Reductions were consistent across uncontrolled and resistant hypertension subgroups.

Baxdrostat also tripled the odds of patients reaching target SBP <130 mmHg compared with placebo, and delivered durable long-term reductions in diastolic and systolic blood pressure. In exploratory analyses, baxdrostat significantly lowered 24-hour and nighttime SBP, important markers of sustained blood pressure control and reduced cardiovascular risk.

The medicine was well tolerated, with no unexpected safety issues. Rates of confirmed hyperkalaemia were low (1.1per cent in each baxdrostat dose group vs 0 per cent in placebo).

Dr. Bryan Williams, Chair of Medicine at University College London and primary investigator, said: “Achieving nearly a 10 mmHg placebo-adjusted reduction with baxdrostat is highly meaningful, as this level of blood pressure lowering is linked to a substantially lower risk of heart attack, stroke, heart failure, and kidney disease. These data highlight the critical role of aldosterone in hard-to-control hypertension and the potential of baxdrostat’s novel mechanism.”

Sharon Barr, Executive Vice President, BioPharmaceuticals R&D, said: “These results show baxdrostat’s potential to address one of the greatest challenges in cardiovascular care — hypertension that persists despite multiple therapies. We are preparing for regulatory submissions and rapidly advancing development programmes exploring baxdrostat in chronic kidney disease, heart failure prevention, and other aldosterone-driven conditions.”

Globally, 1.3 billion people live with hypertension, yet control rates remain poor. In the US, around 50 per cent of patients on multiple therapies still fail to achieve target blood pressure. Aldosterone dysregulation is increasingly recognised as a key driver of hypertension and cardiovascular risk. A 10 mmHg reduction in SBP is estimated to lower the risk of major adverse cardiovascular events by ~20 per cent.