A new medication called baxdrostat has demonstrated the potential to reverse a common cause of high blood pressure, with clinical benefits unexpectedly persisting for up to two years after patients stopped taking the daily pills. This development offers hope to millions of people worldwide living with hypertension, including more than 12 million in the UK.
The findings, published in the New England Journal of Medicine, stem from a small study that tracked 14 patients who showed dramatic improvements in their blood pressure during a three-month trial. After continuing the medication for six to 12 months, the patients ceased treatment. Follow-up examinations conducted up to two years later confirmed that their blood pressure remained lower, with some individuals no longer requiring any hypertension medication and potentially being cured of the condition.
Prof Morris Brown, a hypertension specialist at Queen Mary University of London who led the study, described the results as very exciting. He noted that just under a quarter of the study participants were able to discontinue all treatment while maintaining completely normal blood pressure levels. Baxdrostat is classified as an aldosterone synthase inhibitor (ASI), which works by suppressing the hormone aldosterone. In five to 10 per cent of hypertension cases, the condition is caused by benign tumours or small nodules on the adrenal glands that lead to an overproduction of this hormone, which in turn signals the kidneys to retain salt and raises blood pressure.
While the standard treatment for primary aldosteronism is the surgical removal of the affected adrenal gland, it is not always a complete cure because other factors can contribute to the patient's hypertension. Prof Brown suspects that baxdrostat might offer a curative effect similar to an experiment conducted in mice 20 years ago, where deleting the gene required to produce aldosterone led to the loss of the cells that created the hormone. He believes that by suppressing aldosterone, baxdrostat causes a surge in reactive oxygen species, which may selectively destroy the cells responsible for the hormone's overproduction. This mechanism is currently being tested in laboratory settings.
Mason Freeman, a professor of medicine at Harvard University who participated in the research, cautioned that it is too early to definitively state that patients are cured, noting that a larger trial is currently underway. He added that if the effect is proven to be common and persistent, the approach to diagnosing and treating these patients could change dramatically, potentially allowing them to avoid invasive diagnostic procedures and surgery by using the ASI upon initial suspicion of the condition.
Baxdrostat has already received approval in the US for patients with hypertension that remains uncontrolled by existing drugs. It is currently being assessed by the National Institute for Health and Care Excellence (Nice), which could lead to the drug becoming available through the NHS next year.
