Preliminary research presented at the American Heart Association's Hypertension Scientific Sessions 2025 indicates that baxdrostat, a new medication targeting aldosterone production, may help manage uncontrolled high blood pressure and delay kidney disease progression in patients with chronic kidney disease. The FigHTN Phase 2 clinical trial results showed that adding baxdrostat to standard care reduced systolic blood pressure by approximately 5% and decreased urine albumin loss by 55% compared to placebo.
The study involved 195 participants with an average age of 66 years, all of whom had chronic kidney disease and uncontrolled high blood pressure despite taking maximum tolerated doses of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Participants had an average systolic blood pressure of 151 mm Hg at study initiation, along with elevated urine albumin levels averaging 714 mg/gm of creatinine, indicating significant kidney impairment.
After 26 weeks of treatment, patients receiving either low-dose (0.5 mg-1 mg) or high-dose (2 mg-4 mg) baxdrostat experienced an average systolic blood pressure reduction of 8.1 mm Hg more than those receiving placebo. The medication's mechanism targets aldosterone, a hormone produced by adrenal glands that contributes to both high blood pressure and chronic kidney disease by causing sodium retention, increased water retention, and blood vessel stiffening.
The 55% reduction in urine albumin levels observed in the baxdrostat group suggests potential kidney-protective benefits, comparable to medications known to delay kidney disease progression. High potassium levels occurred in 41% of baxdrostat recipients compared to 5% in the placebo group, though most cases were mild to moderate. Serious adverse events affected 9% of baxdrostat patients versus 3% in the placebo group, with no deaths or unanticipated events reported during the trial.
Dr. Jamie P. Dwyer, lead study author and professor of medicine at University of Utah Health, noted that these findings are particularly encouraging because patients with chronic kidney disease have historically been excluded from many drug studies. The research was simultaneously published in the Journal of the American Society of Nephrology and funded by AstraZeneca, baxdrostat's developer.
Dr. Jordana B. Cohen, immediate past chair of the American Heart Association's Hypertension and Kidney Cardiovascular Science Committee, described this medication class as potentially "game changing" for hypertension management in chronic kidney disease patients. The findings' importance lies in addressing a dangerous cycle where high blood pressure worsens kidney function and declining kidney function further elevates blood pressure, often leading to life-altering outcomes including heart attack, stroke, heart failure, and kidney failure.
Two large Phase 3 trials are now underway to determine if baxdrostat can delay kidney disease progression. The medication is not yet approved by the U.S. Food and Drug Administration for any use. The study was conducted at 71 U.S. sites and included a diverse participant population, with 32% women, 40% non-Hispanic white participants, and 80% having Type 2 diabetes.
