Efficacy and Safety of Baxdrostat in Uncontrolled and Resistant Hypertension

To the Editor: Baxdrostat, an oral aldosterone antagonist, was shown by Flack et al. (Oct. 9 issue) to lead to a substantially lower seated systolic blood pressure in patients with uncontrolled or resistant hypertension than placebo. 1 However, several concerns can be raised. According to clinical guidelines, spironolactone is the standard treatment for resistant hypertension as a fourth-line agent, 2 yet it was neither used as a comparator nor allowed in enrolled patients, which represents a major limitation for applicability to real-world clinical practice. Although given its mechanism of action, baxdrostat would be expected to avoid the hormonal adverse effects of spironolactone, . . .