Key result
Baxdrostat lowers systolic blood pressure by ~7 mmHg versus placebo but increases hyperkalemia risk.
Why the study?
Baxdrostat, a highly selective aldosterone synthase inhibitor studied for uncontrolled and resistant hypertension, has yielded mixed results across different trials, prompting this synthesis of its effects on blood pressure and hyperkalemia risk.
Does baxdrostat reduce systolic blood pressure and affect the risk of hyperkalemia compared to placebo in patients with uncontrolled and resistant hypertension?
Meta-Analysis (n=1,729)
Randomized controlled trials
Does baxdrostat reduce systolic blood pressure and affect the risk of hyperkalemia compared to placebo in patients with uncontrolled and resistant hypertension?
Baxdrostat effectively lowers systolic and diastolic blood pressure in patients with uncontrolled and resistant hypertension, though it significantly increases the risk of hyperkalemia.
Baxdrostat lowers SBP in resistant hypertension; confirms RCT efficacy while requiring hyperkalemia monitoring.
Background Aldosterone synthase inhibitors (ASI) have recently emerged as alternative options for the treatment of uncontrolled and resistant hypertension. Baxdrostat, a highly selective ASI, has been studied in different trials, yielding mixed results. This meta-analysis aimed to summarize its effects on blood pressure and risk of hyperkalemia. Methods A systematic search was conducted on PubMed, Embase, Cochrane and unpublished data for randomized controlled trials (RCT) comparing baxdrostat to placebo for the treatment of patients with uncontrolled and resistant hypertension. The main efficacy outcome was reduction in systolic blood pressure (SBP) and the main safety outcome was the incidence of hyperkalemia. Baxdrostat arms were pooled for trials evaluating multiple doses. Pooled mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) were estimated using a random-effects model with the Restricted Maximum Likelihood estimator. Results Five RCTs with 1729 total patients were included. Baxdrostat significantly reduced SBP (MD -7.08 mmHg; 95% CI -11.68, -2.47; p = 0.01; I² = 73%) and DBP (MD -3.01 mmHg; 95% CI -5.7, -0.31; p = 0.04; I² = 64%) compared to placebo. There was, however, a significant increase in the incidence of hyperkalemia (RR 5.35; 95% CI 1.76, 16.25; NNH 19; I² = 0) and change in serum potassium (MD 0.4 mmol/L; 95% CI 0.26, 0.54). Conclusions Baxdrostat was effective in lowering systolic blood pressure, but increased the risk of hyperkalemia. These results support it as an alternative therapy for uncontrolled and resistant hypertension, with cautious use in patients at risk for hyperkalemia. New evidence is needed for long-term cardiovascular and renal outcomes, as well as comparisons with mineralocorticoid receptor antagonists and other ASIs, concerning efficacy and safety. SBP forest plot HyperK forest plot
No takes yet. Share an insight, caveat, or question.
Bortolotto et al. (2026) conducted a meta-analysis in Uncontrolled and resistant hypertension (n=1,729). Baxdrostat vs. Placebo was evaluated on Reduction in systolic blood pressure (SBP) (MD -7.08 mmHg, 95% CI -11.68 to -2.47, p=0.01). Baxdrostat significantly reduced systolic blood pressure compared to placebo (MD -7.08 mmHg; 95% CI -11.68 to -2.47; p=0.01) while increasing hyperkalemia risk (RR 5.35).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: