Baxdrostat May Reverse Hypertension in Patients With Adrenal Issues

A new medication called baxdrostat has shown the potential to reverse a common cause of high blood pressure, according to research published in the New England Journal of Medicine.

For patients suffering from hypertension triggered by adrenal gland issues, the drug may offer a path away from lifelong daily pills or invasive surgery.

The findings, reported by The Guardian, suggest that the benefits of the drug can persist for up to two years after a patient stops taking it.

This outcome affects the five to 10 percent of hypertensive patients whose condition stems from benign nodules on the adrenal glands, which force the body to overproduce a hormone called aldosterone. This excess hormone signals the kidneys to retain salt, driving blood pressure to dangerous levels.

The Mechanism of Potential Remission

Prof. Morris Brown, a hypertension specialist at Queen Mary University of London who led the study, believes the drug works by selectively destroying the cells responsible for the hormone surge. According to his research, suppressing aldosterone with baxdrostat triggers a surge in highly active molecules known as reactive oxygen species. These molecules may effectively kill the cells that churn out the excess hormone.

It’s very exciting to see. Just under a quarter of the patients came off all treatment and had completely normal blood pressure.

This theory mirrors an experiment conducted in mice two decades ago, where the deletion of the gene responsible for aldosterone production led to the loss of the hormone-producing cells themselves.

While the results are promising, the study was small, involving only 14 patients who showed dramatic improvement during a three-month trial. These individuals continued the medication for six to 12 months before stopping, and follow-up checks two years later confirmed their blood pressure remained at healthy levels.

Shifting the Standard of Care

Currently, the standard medical approach for primary aldosteronism often involves surgical removal of the affected adrenal gland. However, surgery is not always a complete cure, as other factors frequently contribute to a patient’s hypertension. Mason Freeman, a professor of medicine at Harvard University who participated in the research, suggests that if these findings hold true in larger trials, doctors could change how they diagnose and treat hypertension.

“If this effect is common and very persistent then the approach to diagnosing and treating these patients is likely to dramatically change,” Freeman noted. “Everyone could be treated with the ASI in initial suspicion of the condition and if they responded well they could avoid the invasive diagnostic procedures and the surgery.”

Baxdrostat Faces NICE Assessment for NHS Availability

Baxdrostat is classified as an aldosterone synthase inhibitor (ASI). While it has already received approval in the United States for patients whose hypertension remains uncontrolled by existing medications, it is currently under assessment by the National Institute for Health and Care Excellence (Nice). A positive decision could make the drug available through the NHS in the UK by next year.

Despite the optimism, experts caution that it is premature to declare a permanent cure. Larger clinical trials are currently underway to determine if the persistent benefits observed in the initial group are common across a broader, more diverse patient population. Until those results are available, the medical community remains focused on confirming the long-term safety and efficacy of the drug.

For millions of people worldwide living with hypertension, a treatment that addresses the root cause of their condition rather than merely masking the symptoms would change how the disease is managed. The ongoing laboratory work to confirm the mechanism of cell destruction will be the next step in verifying whether this drug can truly move medicine from chronic management to long-term remission.

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