AHA: AZ's baxdrostat impresses in resistant hypertension

AstraZeneca highlighted blood pressure candidate baxdrostat as a programme to watch in its third-quarter results update, and new phase 3 data suggest that optimism is warranted.

In the Bax24 study reported at the AHA, aldosterone synthase inhibitor (ASI) baxdrostat achieved a 16.6 mm Hg reduction in 24-hour ambulatory systolic blood pressure (SBP) in patients with resistant hypertension despite three or more antihypertensive therapies, which compared to a 2.6 mm Hg fall with a placebo.

The positive result, at 12 weeks, was seen across the 24-hour period, including in the early morning when patients with high blood pressure are most at risk of complications like heart attack or stroke.

AZ gave a preview of the data last month that highlighted the result of Bax24 as "highly clinically meaningful," and said last week that it expects the drug to be a major driver of near-term sales growth as it chases down an annual revenue target of $80 billion by 2030.

The topline result of Bax24 was backed up by a string of positive secondary findings, including that significantly more patients treated with baxdrostat (71%) achieved an ambulatory 24-hour average SBP of less than 130 mmHg – the treatment target for most adults with resistant hypertension – compared with the control group (17%).

Lead investigator Dr Bryan Williams of University College London said that the data "could transform treatment practice" for people with resistant hypertension, estimated to be around half of the 1.4 billion people worldwide living with high blood pressure.

AZ has previously said that, given the massive unmet need among patients, baxdrostat could become a $5 billion-a-year product, and said it is preparing to share the data with "regulatory authorities around the world."

The Bax24 data follow impressive results in the BaxHTN study, which also backed the drug's efficacy as an add-on therapy for uncontrolled or treatment-resistant hypertension, and keeps AZ in pace with Mineralys, its main rival in the ASI category.

Mineralys has reported positive data in a pair of phase 3 trials of its lorundrostat candidate earlier this year (Advance-HTN and Launch-HTN) and is preparing to file for approval either this quarter or in early 2026. Last week, it also presented data from the Explore-CKD trial of lorundrostat in chronic kidney disease (CKD) at the American Society of Nephrology (ASN) Kidney Week 2025 congress.

AZ is also developing baxdrostat for CKD and for prevention of heart failure as a combination therapy with its blockbuster SGLT2 inhibitor Farxiga/Forxiga (dapagliflozin), which is approaching the end of its patent life.

It acquired baxdrostat when it bought CinCor Pharma for $1.3 billion in 2023.