A new medication known as baxdrostat has demonstrated the potential to reverse a common cause of high blood pressure, with clinical benefits persisting for up to two years after patients ceased treatment. The findings, published in the New England Journal of Medicine, suggest that some patients may no longer require any hypertension medication, raising the possibility of a long-term cure.
Hypertension affects over a billion people globally, including more than 12 million in the UK. In approximately 5% to 10% of these cases, the condition is driven by benign tumours or small nodules on the adrenal glands that trigger an overproduction of the hormone aldosterone. This excess hormone prompts the kidneys to retain salt, thereby elevating blood pressure. Currently, the standard intervention for this condition, known as primary aldosteronism, involves the surgical removal of the affected adrenal gland, though this does not always resolve the hypertension entirely.
Baxdrostat functions as an aldosterone synthase inhibitor (ASI), suppressing the production of the hormone. The drug has already received approval in the United States for treating hypertension that remains resistant to existing therapies and is currently under review by the National Institute for Health and Care Excellence (Nice) for potential NHS availability next year.
The study followed 14 patients who experienced significant improvements during a three-month trial. After continuing the daily medication for six to 12 months, the patients stopped the treatment. Follow-up examinations conducted up to two years later revealed that their blood pressure remained lower than pre-treatment levels. "It’s very exciting to see," said Prof Morris Brown, a hypertension specialist at Queen Mary University of London who led the study. "Just under a quarter of the patients came off all treatment and had completely normal blood pressure."
Researchers believe the drug may work by selectively destroying the cells responsible for overproducing aldosterone. Prof Brown suggests that by suppressing the hormone, the drug triggers a surge in reactive oxygen species, which may eliminate the problematic cells. "Those oxygen radicals are killing the cells and they disappear," he explained. "That’s what I think the mechanism is and it’s testable, it’s something we’re doing now in the laboratory."
While the results are promising, experts caution that further research is required. Mason Freeman, a professor of medicine at Harvard University, noted that it is currently too early to definitively label the effect as a cure. A larger trial is now underway to confirm these findings. "If this effect is common and very persistent then the approach to diagnosing and treating these patients is likely to dramatically change," Freeman said. "Everyone could be treated with the ASI in initial suspicion of the condition and if they responded well they could avoid the invasive diagnostic procedures and the surgery."
