What if a simple pill finally helped control resistant hypertension? This is the promise of baxdrostat, an experimental drug that has significantly lowered blood pressure in many participants.
Baxdrostat (Baxfendy): a daily pill that targets aldosterone
The BaxHTN phase III clinical trial was conducted on 796 patients across 214 centers. All had resistant or insufficiently controlled high blood pressure despite taking at least two antihypertensive medications. After an optimization phase of their treatment, participants were randomly assigned to receive either 1 mg or 2 mg of baxdrostat once a day, or a placebo, in addition to their usual treatment, for twelve weeks.
The results were presented at the 2025 congress of the European Society of Cardiology, in Madrid, then published on the website of the American medical journal The New England Journal of Medicine.
At the end of three months of treatment, systolic blood pressure had decreased 8.7 to 9.8 mmHg more in patients receiving baxdrostat than in those taking placebo. Furthermore, 40% of treated patients reached a blood pressure below 130 mmHg, compared to 18.7% in the placebo group, according to the European Society of Cardiology.
“What we needed to do was inhibit the production of aldosterone and bring it back to a normal level, so that patients no longer had this high level circulating. And by lowering the aldosterone level with these drugs, we saw blood pressure drop dramatically.” specifies Professor Bryan Williams.
Why could this treatment change the care of certain patients?
Study participants had blood pressure between 140 and 170 mmHg despite already receiving significant treatment. They therefore suffered from uncontrolled or even resistant hypertension when three or more medications were no longer enough to lower their blood pressure.
In this population, who took an average of three antihypertensive drugs, the fact that four out of ten patients reached the blood pressure target with baxdrostat, compared to less than two out of ten on placebo, constitutes a particularly encouraging result.
Baxfendy: where is his authorization?
After the presentation of these results at the 2025 Congress of the European Society of Cardiology, data from the BaxHTN trial led the US Food and Drug Administration (FDA) to authorize Baxfendy in 2026 as a complementary treatment for high blood pressure.