New drug significantly lowers blood pressure – and inspires heart experts from around the world

In Germany , almost 30 percent of the population aged 20 and older is diagnosed with high blood pressure (hypertension). In those affected, the pressure exerted by the blood on the blood vessels from within is too high – in the long term, this damages not only the blood vessels but also the brain, kidneys, eyes, and heart. High blood pressure is therefore considered one of the most important risk factors for various cardiovascular diseases.

• Stroke,
• Heart attack,
• Cardiac arrhythmias
• and heart failure.

If high blood pressure is detected early and treated with medication, for example, those affected can live well with it. The problem: For many patients, conventional medications are ineffective. Despite combinations of sometimes three or more different medications, their blood pressure is not sufficiently reduced.

The researchers investigated the drug Baxdrostat in a clinical study with almost 800 hypertension patients. Participants included people with

• uncontrolled hypertension: elevated blood pressure despite treatment with two medications
• and treatment-resistant hypertension: elevated blood pressure despite treatment with three or more medications

For several weeks, the subjects received either baxdrostat or an ineffective placebo once daily in addition to their usual treatment. The main observations at the 214 different sites were systolic blood pressure—the pressure in the blood vessels when the heart muscle contracts.

Blood pressure is measured in millimeters of mercury (mmHg). Systolic blood pressure measures the pressure during the heartbeat—that is, when the heart muscle contracts and pumps blood into the blood vessels. Diastolic blood pressure measures the pressure on the blood vessels when the heart muscle relaxes—it is lower than systolic blood pressure.

• Optimal blood pressure: 120/80 mmHg or below and values ​​just above
• Mild hypertension : from 140/90 mmHg
• Moderate hypertension: from 160/100 mmHg
• Severe hypertension: 180/110 mmHg as severe hypertension

After twelve weeks of observation, the following results were obtained:

• Nearly 40 percent of the baxdrostat group achieved controlled systolic blood pressure (<130 mmHg). This applies to both the 1 mg and 2 mg doses.
• Only just under 19 percent of the placebo group achieved this value.

The effect of the treatment continued even 32 weeks after the start.

The research team published their data in the New England Journal of Medicine – the study is partly co-financed by the pharmaceutical manufacturer AstraZeneca.

The researchers made another promising discovery. After twelve weeks, they divided the group that had previously received 2 mg of baxdrostat per day into two groups: one continued to receive the dose, the other received only a placebo.

While systolic blood pressure continued to decrease in the baxdrostat group, it increased again in the placebo group – albeit much more slowly than expected. In the study, the research team speculates that the drug may inhibit or even reverse the underlying harmful effects on the vascular system and the activity of the sympathetic nervous system.

• 1.9 percent of patients in the 1 mg baxdrostat group,
• 3.4 percent in the 2 mg baxdrostat group
• 2.7 percent in the placebo group

severe side effects.

The team has thus confirmed the efficacy and safety of baxdrostat in a larger patient group for the first time. Whether the drug will actually be approved for the treatment of hypertension remains to be seen, however. Further long-term studies are planned.

Baxdrostat's mechanism of action is based on a known driver of hypertension: elevated levels of the hormone aldosterone in the blood, which leads to impaired potassium levels. This increases blood volume, which in turn significantly increases blood pressure.

For several years now, there have been medications available that specifically block the effects of aldosterone – including spironolactone and eplerenone.

However, these medications only prevent aldosterone from binding to the corresponding receptors, not from overproduction. Furthermore, these medications have severe side effects. In the case of spironolactone, these include sexual dysfunction and menstrual irregularities.

Researchers have therefore been trying for decades to specifically inhibit aldosterone production, explained Bryan Williams of University College London, one of the lead authors of the study , in a press release .

Now with success: "Baxdrostat is one of the first therapies to do this selectively and lead to a significant reduction in blood pressure in uncontrolled or resistant hypertension," says Williams.

Paul Leeson, professor of cardiology at the University of Oxford, who was not involved in the study, sees potential for a whole new range of drugs: "This new drug could be a potentially valuable additional treatment for combating high blood pressure," he told the British Science Media Center.

And other researchers are also confident: according to media reports, there was even spontaneous applause at the presentation in Madrid.