For patients with SBP >140 mm Hg taking two or more antihypertensives,

BAXFENDY: The first and only FDA-APPROVED aldosterone synthase inhibitor[1a]

MOA

BAXFENDY Mechanism of ActionBAXFENDY Mechanism of Action

OVERVIEW OF ANTIHYPERTENSIVES AND THEIR EFFECTS ON ALDOSTERONE LEVELS

 ACEis and ARBsCCBsTHIAZIDE
DIURETICS		MRAsBAXFENDY (ASI)
How current
treatments work

ACEis inhibit the angiotensin-converting enzyme[7]

ARBs inhibit the binding of angiotensin II to the AT1 receptor[8]

CCBs prevent the movement of calcium into cells of blood vessels[10]Thiazide diuretics inhibit sodium reabsorption in the kidney[12]MRAs bind to the mineralocorticoid receptor and block aldosterone from activating it[13]Directly inhibits aldosterone synthase to decrease aldosterone levels, thereby decreasing blood pressure[1e]
Effect on
aldosterone
levels
Down Arrow Icon ~3% to ~16%[9a],[*]
Down Arrow Icon ~15%[11a],[†]
Up Arrow Icon ~55%[9b],[*]
Up Arrow Icon ~25% to
120%[14a],[15a],[16a],[17a],[18a],[‡]
Down Arrow Icon ~70%[1f]
It is unknown if pharmacologic differences correlate with efficacy or safety.
There are no head-to-head clinical trials comparing these therapeutic classes to BAXFENDY.[1g]

*^ Based on a randomized, open-label trial that assessed aldosterone escape in patients with mild-to-moderate hypertension (n=64) treated for 12 weeks with antihypertensives, including an ACEi, an ARB, a diuretic, or an ACEi+ARB combination. From Week 0 to Week 12, quinapril (20 mg/day) lowered plasma aldosterone by 15.8% (7.6–6.4) and irbesartan (150 mg/day) lowered aldosterone by 2.5% (8.0–7.8), while aldosterone levels increased by 54.9% with a hydrochlorothiazide diuretic (25 mg/day; 9.1–14.1).[9c]

†^ In a randomized study of patients with hypertension and suspected PA (n=230) that evaluated the effects of single antihypertensive therapies prescribed for >2 months on ARR, amlodipine (10 mg/day) reduced PAC by 14.72% (29.2–24.9).[11b]

‡^ In a study of healthy volunteers who received eplerenone (100 mg/day) for 10 days, a 120% increase in serum aldosterone AUC was observed.[15b] In a separate study that evaluated the effects of spironolactone (25 mg/day) on PAC in patients with resistant hypertension (n=39), PAC increased by 24.67% (15.4–19.2) after 6 months of therapy.[14b] Increases in aldosterone levels were observed within this range in other studies, including a retrospective study of patients with hypertension treated with MRAs (n=146; 62% of whom were diagnosed with PA), a separate randomized, controlled, dose-ranging trial in Japanese patients with essential hypertension (n=193), and another randomized study using the subset cohort of patients from the EPHESUS trial (n=453).[16b],[17b],[18b]

Consider a new approach at 3rd line for your patients with uncontrolled hypertension

Discover the data

Abbreviations: ACEi=angiotensin-converting enzyme inhibitor; ARB=angiotensin receptor blocker; ARR=aldosterone-renin ratio; ASI=aldosterone synthase inhibitor; AUC=area under the curve; CCB=calcium channel blocker; FDA=Food and Drug Administration; MRA=mineralocorticoid receptor antagonist; PA=primary aldosteronism; PAC=plasma aldosterone concentration; SBP=systolic blood pressure.

References:

  1. 1a 1b 1c 1d 1e 1f 1g BAXFENDY® (baxdrostat) [prescribing information]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2026.
  2. ^ Papadopoulou-Marketou N, Vaidya A, Kaltsas G, et al. Hyperaldosteronism. In: Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc. Updated February 16, 2026. Accessed April 5, 2026. https://www.ncbi.nlm.nih.gov/books/NBK279065
  3. 3a 3b Guzik TJ, Tomaszewski M. Aldosterone synthase inhibition for hypertension. N Engl J Med. 2025;393(14):1436-1439.
  4. 4a 4b Flack JM, Azizi M, Brown JM, et al; BaxHTN Investigators. Efficacy and safety of baxdrostat in uncontrolled and resistant hypertension [including online supplement]. N Engl J Med. 2025;393(14):1363-1374.
  5. 5a 5b Azizi M, Brown JM, Dwyer JP, et al; Bax24 investigators. Effect of baxdrostat on ambulatory blood pressure in patients with resistant hypertension (Bax24): a phase 3, randomised, double-blind, placebo-controlled trial [including online supplement]. Lancet. 2026;407(10532):988-999.
  6. ^ Bogman K, Schwab D, Delporte M-L, et al. Preclinical and early clinical profile of a highly selective and potent oral inhibitor of aldosterone synthase (CYP11B2). Hypertension. 2017;69(1):189- 196.
  7. ^ Singh B, Cusick AS, Goyal A, et al. ACE inhibitors. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Updated May 4, 2025. Accessed April 5, 2026. https://pubmed.ncbi.nlm.nih.gov/28613646/
  8. ^ Patel P, Launico MV. Angiotensin II receptor blockers (ARB). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Updated May 5, 2025. Accessed April 5, 2026. https://pubmed.ncbi.nlm.nih.gov/30725712/
  9. 9a 9b 9c Ubaid-Girioli S, Ferreira-Melo SE, Souza LA, et al. Aldosterone escape with diuretic or angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker combination therapy in patients with mild to moderate hypertension. J Clin Hypertens (Greenwich). 2007;9(10):770-774.
  10. ^ McKeever RG, Patel P, Hamilton RJ. Calcium channel blockers. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Updated February 22, 2024. Accessed April 5, 2026. https://pubmed.ncbi.nlm.nih.gov/29494080/
  11. 11a 11b Mulatero P, Rabbia F, Milan A, et al. Drug effects on aldosterone/plasma renin activity ratio in primary aldosteronism. Hypertension. 2002;40(6):897-902.
  12. ^ Patel P, Preuss CV. Thiazide diuretics. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Updated July 6, 2025. Accessed April 5, 2026. https://www.ncbi.nlm.nih.gov/books/NBK532918/
  13. ^ Patibandla S, Heaton J, Kyaw H. Spironolactone. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Updated July 4, 2023. Accessed April 5, 2026. https://www.ncbi.nlm.nih.gov/books/NBK554421/
  14. 14a 14b Ubaid-Girioli S, de Souza LA, Yugar-Toledo JC, et al. Aldosterone excess or escape: treating resistant hypertension. J Clin Hypertens (Greenwich). 2009;11(5):245-252.
  15. 15a 15b Eudy RJ, Sahasrabudhe V, Sweeney K, et al. The use of plasma aldosterone and urinary sodium to potassium ratio as translatable quantitative biomarkers of mineralocorticoid receptor antagonism. J Transl Med. 2011;9:180.
  16. 16a 16b Kobayashi M, Pitt B, Ferreira JP, et al. Interaction between aldosterone and mineralocorticoid receptor antagonist: findings from the EPHESUS trial. JACC Heart Fail. 2025;13(8):102479.
  17. 17a 17b Saruta T, Kageyama S, Ogihara T, et al. Efficacy and safety of the selective aldosterone blocker eplerenone in Japanese patients with hypertension: a randomized, double-blind, placebo-controlled, dose-ranging study. J Clin Hypertens (Greenwich). 2004;6(4):175-185.
  18. 18a 18b Tezuka Y, Turcu AF. Mineralocorticoid receptor antagonists decrease the rates of positive screening for primary aldosteronism. Endocr Pract. 2020;26(12):1416-1424.