Weekly Journal Scan: Aldosterone synthase inhibition with baxdrostat improves 24-hour blood pressure control in patients with treatment resistant hypertension

Comment on ‘Effect of baxdrostat on ambulatory blood pressure in patients with resistant hypertension (Bax24): a phase 3, randomized, double-blind, placebo-controlled trial’ which was published in The Lancet, doi: 10.1016/S0140-6736(25)02549-8 A large body of evidence has shown that ambulatory BP levels are strongly associated with major cardiovascular events (MACEs).2 Moreover, the most recent international guidelines suggest out-of-office BP monitoring both to ensure the achievement of office BP targets and to confirm the diagnosis of resistant hypertension.3,4 Based on these premises and on the fact that aldosterone dysregulation is recognized as a contributor to difficult-to-control and resistant hypertension,5–7 the Bax24 study1 represents a timely investigation to test the efficacy of baxdrostat, a highly selective ASI, in reducing ambulatory BP in patients with resistant hypertension. The BP-lowering effectiveness of baxdrostat on top of standard-of-care antihypertensive treatment has been previously demonstrated in the BaxHTN (A Study to Investigate the Efficacy and Safety of Baxdrostat in Participants with Uncontrolled Hypertension on Two or More Medications, Including Participants with Resistant Hypertension), using office BP measurements, in patients with uncontrolled and resistant hypertension.8,9