A newly developed drug, baxdrostat, has demonstrated remarkable efficacy in providing 24-hour protection against high blood pressure, particularly during early mornings when the risk of heart attacks and stroke is at its peak. This breakthrough offers a significant advancement in managing hypertension.

Blood pressure levels are heavily influenced by aldosterone, a hormone produced by the adrenal glands, which plays a critical role in maintaining blood pressure by regulating sodium and potassium levels. In some individuals, an overproduction of aldosterone leads to the body retaining excessive salt and water, consequently elevating blood pressure. While existing medications have been able to block aldosterone's activity, baxdrostat introduces a novel approach by directly inhibiting the production of this hormone.

The global Bax24 trial, a pivotal study, enrolled 218 participants from 79 locations worldwide. All participants suffered from treatment-resistant high blood pressure, meaning their condition remained elevated despite taking at least three other types of medication. The study, spearheaded by Professor Bryan Williams from University College London (UCL) and a distinguished professor of cardiovascular science, definitively concluded that baxdrostat was effective over a full 24-hour period.

Professor Williams commented on the trial's findings, describing the results as "quite remarkable" due to both the substantial reduction in blood pressure and its sustained effect throughout the entire day. He further noted that the effectiveness of baxdrostat is unprecedented, suggesting that aldosterone plays a crucial role in driving up blood pressure in many patients whose conditions are difficult to control with current treatments. This represents a "real advance in our understanding of treatment-resistant hypertension and a major breakthrough in new treatment options," with the potential to benefit a vast number of people.

During the study, participants received either baxdrostat or a placebo once daily in tablet form, in addition to their ongoing treatments. Their blood pressure was meticulously monitored using a 24-hour ambulatory blood pressure monitoring (ABPM) device, which provides a more accurate measure compared to sporadic clinic readings. After 12 weeks, individuals taking baxdrostat experienced a very substantial and consistent reduction in blood pressure across the entire day, including during the night and the critical early morning hours. The results were presented at the American Association Scientific Sessions in New Orleans.

This follows an earlier trial involving 800 patients, which also highlighted the promising effects of baxdrostat. In that study, patients administered baxdrostat saw their blood pressure decrease by approximately nine to 10mmHg more than those on a placebo after 12 weeks. Crucially, about four out of ten patients achieved healthy blood pressure levels, a significant improvement compared to fewer than two out of ten in the placebo group, all without any unanticipated safety concerns. Research suggests that such a reduction in blood pressure can decrease the risk of coronary heart disease by 17%, stroke by 27%, heart failure by 28%, and overall mortality by 13%.

High blood pressure is a widespread health concern, affecting an estimated 14 million people in the UK. Worryingly, for half of these individuals, the condition remains uncontrolled or resistant to treatment, even when they are on multiple medications. These patients face a heightened risk of severe complications, including heart attack, stroke, kidney disease, and premature death. The British Heart Foundation also warns that many in the UK may be living with undiagnosed high blood pressure, with symptoms ranging from headaches and blurred vision to chest pain and nosebleeds, according to the NHS.

While the risk of high blood pressure typically increases with age, other significant risk factors include a family history of hypertension, ethnicity, an unhealthy diet, being overweight, smoking, alcohol consumption, and chronic stress. Individuals concerned about their blood pressure can seek checks at local pharmacies, many of which offer free screenings for those aged 40 or older, or consult their GP surgery.

Looking ahead, baxdrostat could become available on the NHS as early as next year. Its manufacturer, AstraZeneca, is preparing to submit applications for regulatory approval within the coming months, signaling a potential new era in the management of stubborn high blood pressure.