Baxdrostat (Baxfendy®), a first-in-class aldosterone synthase inhibitor approved for adults with uncontrolled hypertension.

Abstract

Despite the availability of multiple antihypertensive therapies, many patients remain unable to achieve adequate blood pressure control. Excess aldosterone is a key contributor to resistant and uncontrolled hypertension. Baxdrostat (Baxfendy®), a first-in-class selective aldosterone synthase (CYP11B2) inhibitor, was approved on May 15, 2026, for use in adults with inadequately controlled hypertension receiving other antihypertensive medications. Unlike mineralocorticoid receptor antagonists, baxdrostat reduces aldosterone biosynthesis while preserving cortisol production, offering a distinct mechanism of action. In phase 3 clinical trials, once-daily baxdrostat (1-2 mg) produced placebo-adjusted reductions of ~ 9-10 mmHg in seated systolic blood pressure. Hyperkalemia was generally manageable, with no clinically meaningful cortisol suppression observed. These findings support baxdrostat as a promising new option for patients with difficult-to-control hypertension.