Baxdrostat Efficacy and Safety in Uncontrolled or Resistant Hypertension: A Meta-Analysis

Introduction: Resistant hypertension remains difficult to control and is associated with increased cardiovascular and renal risk. Baxdrostat, a selective aldosterone synthase inhibitor, has emerged as a potential therapeutic option for adults with uncontrolled or resistant hypertension. We evaluated the efficacy and safety of baxdrostat in adults with uncontrolled or resistant hypertension. Methods: We included placebo-controlled randomized controlled trials evaluating baxdrostat 0.5-2 mg over 12-24 weeks. Outcomes were pooled as mean differences (MDs) with 95% confidence intervals (CIs) using a DerSimonian-Laird random-effects model. Heterogeneity was assessed using I 2 . Analyses were performed using STATA 19MP. Missing standard deviations were derived from standard errors or graphically extracted data when required. Results: Three randomized controlled trials were included. Compared with placebo, baxdrostat significantly reduced seated systolic blood pressure (MD -8.62 mmHg, 95% CI -10.55 to -6.70; P<0.001; Figure A ) and seated diastolic blood pressure (MD -3.55 mmHg, 95% CI -4.81 to -2.28; P<0.001; Figure B). Baxdrostat also reduced aldosterone levels (MD -4.03 ng/dL; P<0.001). Expected laboratory changes were observed, including a reduction in estimated glomerular filtration rate (MD -5.49 mL/min/1.73 m 2 ; P<0.001) and an increase in serum potassium (MD 0.39 mmol/L; P<0.001). Adverse events were more frequent with baxdrostat than placebo, but no adrenal insufficiency was reported. Conclusion: Baxdrostat provides clinically meaningful reductions in systolic and diastolic blood pressure in adults with uncontrolled or resistant hypertension. These benefits are accompanied by expected changes in renal function and serum potassium, supporting the need for potassium and renal monitoring during treatment.