Key result
Baxdrostat lowers systolic blood pressure up to ~8 mmHg in treatment-resistant hypertension.
Why the study?
The efficacy and safety of the aldosterone synthase inhibitor baxdrostat in individuals with treatment-resistant hypertension required systematic evaluation.
Does baxdrostat (1 mg and 2 mg) reduce systolic and diastolic blood pressure in patients with treatment-resistant hypertension?
Meta-Analysis
Randomized controlled trials
Does baxdrostat (1 mg and 2 mg) reduce systolic and diastolic blood pressure in patients with treatment-resistant hypertension?
Baxdrostat at 1 mg and 2 mg significantly reduces systolic and diastolic blood pressure in patients with treatment-resistant hypertension, though it is associated with an increased risk of hyperkalemia and overall adverse events.
Answers are grounded in this paper and cite their sources.
May add baxdrostat as an option in resistant hypertension with potassium monitoring; extends evidence for aldosterone synthase inhibition.
Background: Hypertension is one of the primary contributors to the global burden of non-communicable diseases. Individuals who maintain blood pressure levels above the target range, despite being on maximally tolerated doses of three or more different classes of antihypertensive drugs, are classified as treatment-resistant hypertension. This systematic review and meta-analysis will explore the efficacy and safety of baxdrostat, an aldosterone synthase inhibitor, in treatment-resistant hypertension. Methods: A systematic search was performed from inception to September 15, 2025. Quantitative synthesis was performed using Review Manager software (version 5.4). Continuous outcomes were reported as mean difference (MD) and dichotomous outcomes were reported as risk ratio (RR), along with their 95% confidence intervals (CI). Results: Four randomized controlled trials (RCTs) were included. For systolic blood pressure (SBP), baxdrostat demonstrated a statistically significant reduction in both 1 mg and 2 mg doses (MD: -6.19, P = 0.010; MD: -7.90, P < 0.00001, respectively). For diastolic blood pressure (DBP), baxdrostat demonstrated a statistically significant reduction in both 1 mg and 2 mg doses (MD: -2.66, P = 0.03; MD: -3.12, P = 0.004, respectively). Baxdrostat was associated with increased risk of any adverse events in both doses (RR: 1.23, P = 0.004; RR: 1.23, P = 0.04, respectively), but no differences were observed for severe adverse events. Importantly, hyperkalemia was significantly associated in both 1 mg and 2 mg doses (RR: 4.43, P = 0.0007; RR: 5.68, P = 0.04, respectively). Conclusion: In conclusion, baxdrostat significantly lowers SBP and DBP in treatment-resistant hypertension at all doses. In terms of safety profile, baxdrostat was associated with any adverse events, including hyperkalemia, at both doses, but not related to severe adverse events. This novel class represents a promising therapeutic advancement, although further phase III trials are needed to arrive at a valid conclusion.
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Rizvi et al. (2026) conducted a meta-analysis in Treatment-resistant hypertension. Baxdrostat was evaluated on Systolic blood pressure (SBP) (MD -7.90 (2 mg); MD -6.19 (1 mg), p=<0.00001). Baxdrostat significantly reduced systolic blood pressure in treatment-resistant hypertension at both 1 mg (MD -6.19, P=0.010) and 2 mg doses (MD -7.90, P<0.00001), though increasing hyperkalemia risk.
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