Efficacy and Safety of Baxdrostat for Patients With Uncontrolled or Resistant Hypertension: A Systematic Review and Meta-Analysis

Abstract

We evaluated the efficacy and safety of baxdrostat in adults with uncontrolled or resistant hypertension. We searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL from inception to January 2026. We included randomized controlled trials that involved hypertension patients with resistance type and compared baxdrostat versus placebo. The primary outcomes were the changes in mean seated systolic blood pressure and diastolic blood pressure. Secondary outcomes included changes in estimated glomerular filtration rate (eGFR), serum potassium, and serum aldosterone. Three randomized controlled trials were finally included, comprising 1264 patients were followed for 12-24 weeks. Compared with placebo, baxdrostat reduced seated systolic blood pressure by 8.62 mm Hg [mean difference (MD) = -8.62, 95% confidence interval (CI), -10.55 to -6.70, P < 0.001] and seated diastolic blood pressure by 3.55 mm Hg (MD = -3.55, 95% CI, -4.81 to -2.28, P < 0.001). Baxdrostat lowered serum aldosterone by 4.03 ng/dL, reduced eGFR by 5.49 mL/min/1.73 m2, and increased serum potassium by 0.39 mmol/L. However, baxdrostat was associated with higher adverse events compared with the placebo. Baxdrostat lowers blood pressure and aldosterone levels in uncontrolled and resistant hypertension but increases potassium and modestly reduces eGFR, supporting careful laboratory monitoring and longer trials to evaluate long-term clinical outcomes.