Baxdrostat Pill May Cure a Common Cause of High Blood Pressure

A pill that keeps working after you stop taking it

A once-daily pill may do something no blood pressure drug has done before: keep working long after patients stop taking it.

Researchers at Queen Mary University of London report that baxdrostat, a drug that blocks production of the hormone aldosterone, drove a common hormonal cause of high blood pressure into remission in a small group of patients — and the benefit lasted for up to two years after treatment ended.

The findings, published in the New England Journal of Medicine on 7 November, followed 14 patients treated at eight centres across the United States. All had responded well to the drug in an earlier trial, then continued taking it for between six and 12 months.

The study was reported by MedicalXpress on 7 November.

Just under a quarter of the patients came off all blood pressure treatment and still had completely normal readings, according to the study’s lead author, Professor Morris Brown.

“Just under a quarter of the patients came off all treatment and had completely normal blood pressure,” Brown said.

Targeting the hormone behind the problem

High blood pressure affects roughly a third of adults, and in 5 to 10 per cent of cases the cause is a condition called primary aldosteronism. Small, non-cancerous nodules on the adrenal glands — the glands that sit just above the kidneys — pump out too much aldosterone, a hormone that makes the kidneys retain salt and water, pushing blood pressure up.

Until now, the only way to cure primary aldosteronism has been surgery to remove an entire adrenal gland. Most patients instead take blood pressure medicines for life.

Baxdrostat works differently. It is an aldosterone synthase inhibitor, which means it switches off the production of aldosterone at its source rather than simply masking its effects. The drug, made by AstraZeneca, was approved in the United States earlier this year for adults whose blood pressure remains uncontrolled despite taking other medicines.

The numbers behind the hope

The results in the 14 patients were striking. A key marker of excess aldosterone production fell by 99 per cent compared with before treatment. Average systolic blood pressure — the top number in a reading — dropped from 142.4 to 117.2 millimetres of mercury, a fall of around 25 points.

Crucially, the improvements did not fade when the pills stopped. Follow-up measurements taken up to two years later showed blood pressure remained substantially lower, with some patients needing no hypertension drugs at all.

The approach has been given the name extended aldosterone synthase inhibition, or EASI: a finite course of treatment, lasting six to 12 months, aimed at a lasting reset rather than lifelong control.

Why doctors are urging caution

The researchers themselves are careful not to overstate what a study of 14 people can prove. There was no comparison group, and the patients were selected because they had already responded well to the drug in an earlier trial.

Mason Freeman, a professor of medicine at Harvard University who was involved in the work, said it was too early to say whether some of the patients were cured, and that a larger trial was under way to find out.

Recent results elsewhere show how early promise can fade: a Novartis heart drug trial cut a risk marker by 78 per cent yet failed to prevent heart attacks.

That larger trial, called ELIXIR, is now being led by the same team to test whether the results can be repeated in a bigger group of patients. Full findings are not expected until late 2028.

What happens next

In Britain, the National Institute for Health and Care Excellence is assessing whether baxdrostat should be made available through the NHS, with a decision that could see the drug offered as early as next year. In the United States, where the drug is already approved for uncontrolled hypertension, the question now is whether regulators and doctors will one day be able to offer it as a short course with lasting effect.

Regulators continue to tighten safety oversight of widely used medicines, as shown by the recent FDA warning on GLP-1 drugs.

Health researchers are also watching other emerging risks, including a study tracking a deadly soil bacterium in the US.

For the millions of people who take blood pressure tablets every day for life, the idea of a treatment that ends — rather than one that never does — is a genuine change of direction. The evidence is early, the numbers are small, and the word “cure” still needs proving. But for the first time, researchers can point to patients who stopped their pills and stayed well.