In a small follow-up study, 14 patients kept lower blood pressure for up to two years after they stopped taking baxdrostat, The Guardian reported. Most people expect high blood pressure to need pills for life. Researchers now think the drug may wipe out certain adrenal gland cells. In some patients, these cells make too much of a hormone called aldosterone, which pushes blood pressure up.
Baxdrostat is sold under the brand name Baxfendy. It is an aldosterone synthase inhibitor. That means it lowers aldosterone, a hormone made by the adrenal glands. Aldosterone controls how much salt and water the kidneys hold on to. The drug was first tested as a daily pill for people whose blood pressure other drugs couldn’t control. No one planned for the effect to last after patients stopped. It showed up in follow-up checks. Now researchers are asking if, for some people, the drug fixes the cause and not just the symptoms.
Primary aldosteronism is a condition where the adrenal glands make too much aldosterone. It is the most common hormone-related cause of high blood pressure. It affects at least 1 in 10 people with high blood pressure. For years, surgery was the only way to treat the root problem. A pill that could do the same, or have a lasting effect, would be a big change.
What the small study actually found
The 14 patients had all responded very well to baxdrostat in a three-month trial. Their blood pressure had dropped a lot. They stayed on the drug for another six to 12 months. The first trial was not set up to check for long-term effects. Doctors checked on the patients up to two years later. Their blood pressure remained lower. Nearly a quarter of them could stop all their blood pressure pills and still have normal readings.
Prof Morris Brown led the research at Queen Mary University of London. He said: “Just under a quarter of the patients came off all treatment and had completely normal blood pressure.”
Mason Freeman is a Professor of Medicine at Harvard Medical School. He said it is too early to know if any patients were cured. But if the effect turns out to be common and lasting, it could change how these patients are diagnosed and treated. Some might be able to skip invasive tests and surgery if the drug works for them first.
Read More: Popular Blood Pressure Drug Linked to Higher Risk of Low Potassium and Kidney Problems
How does baxdrostat work?
Aldosterone is made in the outer layer of the adrenal glands. It tells the kidneys to hold on to salt. That raises the amount of fluid in the body, which raises blood pressure. Baxdrostat blocks the enzyme that makes aldosterone. This enzyme comes from a gene called CYP11B2. The drug does this without affecting cortisol, another adrenal hormone, according to a 2026 research review.
Most blood pressure drugs block aldosterone’s effects after it is made. Baxdrostat stops the body from making it in the first place. Researchers see too much aldosterone as the main hormone problem behind high blood pressure in these patients.
The cellular mechanism researchers suspect
Prof Brown thinks baxdrostat may do more than lower a hormone level. His idea comes from a mouse study done about 20 years ago. In that study, removing the gene needed to make aldosterone made the cells that produce it disappear. He believes baxdrostat may do something similar in people.
When the drug lowers aldosterone, it causes a spike in unstable molecules called reactive oxygen species. These may kill off the faulty, overactive adrenal cells that make too much hormone. Brown said: “Those oxygen radicals are killing the cells and they disappear. That’s what I think the mechanism is and it’s testable, it’s something we’re doing now in the laboratory.”
This idea has not been proven in people yet. It matches what happened in the mice, and it could explain what doctors saw in patients. A larger, more careful study is needed to confirm it.
How common is aldosterone-driven high blood pressure?
High blood pressure is one of the most common long-term health problems in the world. Standard treatment keeps it under control but rarely fixes the cause. So most patients take pills every day for life. For primary aldosteronism, the usual treatment is surgery to remove the affected adrenal gland. But surgery doesn’t always cure high blood pressure, because other causes may still be there.
Primary aldosteronism affects at least 1 in 10 people with high blood pressure, according to a 2024 study. Many people with it are never diagnosed. One reason is that testing needs special hormone blood tests that aren’t part of a normal blood pressure checkup. For these patients, a drug that might remove the cause, not just manage symptoms, would be a new kind of treatment.
You can read more about how resistant hypertension is now being addressed in What the new high blood pressure warnings mean for you.
The clinical trial results supporting the drug
The follow-up was built on data from a large Phase III trial. Phase III is the final major stage of testing before approval. The trial, called BaxHTN, was published in the New England Journal of Medicine. It included 796 patients. They were split into three equal groups. One group took baxdrostat 2mg, one took 1mg, and one took a placebo (a dummy pill), once a day for 12 weeks. On the 2mg dose, systolic blood pressure (the top number) dropped by 15.7 mmHg while sitting. On the placebo, it dropped by 5.8 mmHg. That is a difference of 9.8 mmHg.
Prof Brown was also a co-senior author of the trial. He is Professor of Endocrine Hypertension at Queen Mary University of London. He said: “The results of this first-of-its-kind drug are exciting, although more testing is required.” A 2025 commentary in Nature Hypertension looked at the trial. It found that approximately 40% of patients achieved a systolic blood pressure below 130 mmHg on baxdrostat. On placebo, fewer than 20% did.
In the trial, few patients had confirmed hyperkalemia, according to AstraZeneca. Hyperkalemia is a rise in blood potassium that can be dangerous. Older drugs that block aldosterone, like spironolactone, cause it more often.
Approval, access, and further research
The FDA approved baxdrostat on May 15, 2026, for adults whose high blood pressure is not under control, according to AstraZeneca. It was the first drug of its kind approved in the United States. It is only meant for people whose blood pressure stays high on other drugs. It is not a first choice treatment.
Outside the US, it is hard to get. Baxdrostat has not been widely approved in other countries, so access depends on where you live.
A larger study to check the follow-up results has already started. Baxdrostat is also being tested as a treatment for primary aldosteronism itself, according to AstraZeneca.
What this means for you
Baxdrostat is not widely available outside the US. In the US, it is only for people whose high blood pressure is hard to control. The 14-patient results are early. The group was small, and the way the drug might work has not been proven in people. Do not change or stop your blood pressure medicine based on these results.
For people with hard-to-treat high blood pressure caused by too much aldosterone, the usual outlook has been pills for life or surgery. These early results, along with the Phase III trial, suggest that may not be true for everyone. Primary aldosteronism affects about 1 in 10 people with high blood pressure, and it is often missed. If you’ve been told your blood pressure is hard to control, ask your doctor if this condition has been ruled out.
Disclaimer: The author is not a licensed medical professional. The information provided is for general informational and educational purposes only and is based on research from publicly available, reputable sources. It is not intended to constitute, and should not be relied upon as, medical advice, diagnosis, or treatment. Always consult a licensed physician or other qualified healthcare provider regarding any medical condition, symptoms, or medications. Do not disregard, avoid, or delay seeking professional medical advice or treatment because of information contained herein.
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