New drug effectively controls resistant hypertension in Lancet study

A drug called baxdrostat significantly reduced 24-hour ambulatory systolic blood pressure in individuals with hard-to-control hypertension a recent study published in the Lancet shows. 

The Bax24 trial was an international, multicentre, randomised, double-blind, placebo-controlled study, funded by AstraZeneca.

It enrolled 218 patients at 79 clinical sites across 22 countries who all had resistant hypertension – meaning their blood pressure remained high despite taking at least three different medications. As part of the study, they took either baxdrostat or a placebo once daily in tablet form, alongside their usual treatment.

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The study was led globally by Professor Bryan Williams, University College London Institute of Cardiovascular Science, who said: ‘For millions of people, high blood pressure is difficult to control, even with multiple medications. Persistent high blood pressure massively increases the risk of heart disease, stroke, and kidney disease.’

‘The Bax24 trial results are quite remarkable both in terms of the magnitude of blood pressure reduction and the fact that it was sustained across the entire 24hr period. The effectiveness of this drug is unprecedented and suggests that the hormone aldosterone, which the drug targets, is playing a very important role in driving up blood pressure in many of the patients we struggle to control with existing treatments.’

‘This is a real advance in our understanding of treatment resistant hypertension and a major breakthrough in new treatment options.’

Because dysregulation of aldosterone – a hormone that can drive high blood pressure in some people – plays a major role in the development of uncontrolled or resistant hypertension, the researchers investigated whether baxdrostat, a selective aldosterone synthase inhibitor, could improve control of resistant hypertension.

In Bax24, they found that 2 mg baxdrostat lowered blood pressure by an average of −16.6 mm Hg compared with −2·6 mm Hg in the placebo group a difference of 14·0 mm Hg. These findings help to substantiate the results of BaxHTN and suggest that baxdrostat can meaningfully lower cardiovascular risk, and help twice as many participants reach healthy blood pressure levels compared with placebo.

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Sharon Barr, executive vice president, BioPharmaceuticals research and development at AstraZeneca, which acquired baxdrostat in 2023, said: ‘The Bax24 data demonstrate the significant impact that baxdrostat’s long half-life and highly selective inhibition of aldosterone synthase can have in improving 24-hour and overnight blood pressure for patients with resistant hypertension. Patients with elevated night-time blood pressure are especially vulnerable to cardiovascular events, including heart attack and stroke.’

‘Together with the results from BaxHTN, these findings demonstrate the potential of baxdrostat to redefine what is possible for the millions of patients whose hypertension remains uncontrolled despite current therapies.’

The findings of Bax24 build on results from a related study, BaxHTN, which was published by the same team in August 2025 in the New England Journal of Medicine.

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That study, showed that baxdrostat could reduce blood pressure in people with uncontrolled or resistant hypertension. With Bax24 demonstrating that this effect can be sustained over 24 hours.

A version of this article was first published by our sister title The Pharmacist