A new drug designed to treat stubborn high blood pressure has reached the market, offering a fresh approach for patients who don’t respond to standard treatments.
Aldosterone’s role in resistant hypertension
Resistant hypertension affects millions globally. The condition is defined as blood pressure that remains raised despite taking three or more medications, including a diuretic. For these patients, the hormone aldosterone frequently contributes to the problem.
The hormone, produced by the adrenal glands, controls sodium and fluid balance. Overactivity can lead to high blood pressure, inflammation in blood vessels, and damage to the heart and kidneys. Studies now indicate excess aldosterone occurs more often in resistant hypertension than previously recognized.
How baxdrostat works
The newly approved medication, baxdrostat (brand name Baxfendy), addresses aldosterone at its origin. Older drugs like spironolactone and eplerenone block aldosterone’s effects after production, but baxdrostat prevents the hormone from forming.
It achieves this by inhibiting CYP11B2, the enzyme responsible for aldosterone’s final production step. The drug is highly selective, avoiding interference with CYP11B1, the enzyme involved in cortisol synthesis. This precision may limit side effects tied to cortisol disruption, an issue seen with broader-acting medications.
Clinical trial results
A phase 2 trial, BrigHTN, tested baxdrostat in patients with resistant hypertension already taking multiple blood pressure medications. Participants receiving the drug experienced significant drops in systolic blood pressure compared to a placebo, with higher doses yielding greater reductions. The trial also confirmed the medication lowered aldosterone levels in the blood.
Follow-up studies demonstrated sustained blood pressure improvements, and regulators deemed the safety profile acceptable. These results supported its approval.
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For patients who’ve exhausted other options, baxdrostat may reduce pill burden while improving control. Uncontrolled hypertension increases risks of heart attacks, strokes, and kidney failure. A treatment that finally helps these patients could also shift medical approaches to the condition.
What pharmacists need to know
Pharmacists will be essential in managing patients using baxdrostat. Monitoring will include regular checks of blood pressure, potassium levels, and kidney function. Since the drug reduces aldosterone, it may raise potassium, requiring patients to watch for hyperkalemia symptoms like muscle weakness or irregular heartbeat. They should also avoid other medications that raise potassium.
Lifestyle adjustments, such as reducing salt intake, maintaining a healthy weight, and staying active, remain important. The medication complements these habits rather than replacing them.
Pharmacists can also offer practical tips to help patients manage their health safely.
Future possibilities
Baxdrostat is the first drug to directly target aldosterone synthesis. Its approval represents one of the most significant advances in hypertension treatment in recent years. Scientists are now exploring whether it can provide additional benefits, such as long-term protection for the heart and kidneys. If these studies succeed, the drug’s applications could extend beyond resistant hypertension.
For now, it provides a new option for patients who had few left.