Baxdrostat for High Blood Pressure: Cost, Side Effects and Who Should Consider It
This new blood pressure drug shows promise—here’s how it works and what to watch for
Key Takeaways
- Baxdrostat is a new BP med pending FDA approval that lowers resistant high blood pressure.
- Those with kidney dysfunction may need to avoid baxdrostat or require careful monitoring.
- Baxdrostat may not be a first-line medicine due to its expected higher cost.
With almost half of American adults living with high blood pressure, it makes sense that you’d want every possible tool in your arsenal to reduce your numbers and get your blood pressure into a healthy range. You’ve likely heard of ACE inhibitors, and now there’s a new class of medications called aldosterone synthase inhibitors (ASIs). A new study in the New England Journal of Medicine shows that one member of this family, called baxdrostat, shows promise in significantly lowering blood pressure in those who don’t benefit from traditional medications.
Here, a leading endocrinologist who has studied baxdrostat shares everything you need to know, including who is a good candidate for the drug, potential side effects and how it may be combined with other blood pressure-lowering medications.
What is baxdrostat?
Baxdrostat is an oral, once-daily medication that blocks the production of a protein made in the adrenal gland that’s responsible for producing a hormone called aldosterone, explains Mason W. Freeman, MD, an endocrinologist and director of the Translational Research Center at Massachusetts General Hospital and professor at Harvard Medical School.
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“Aldosterone is a major regulator of blood pressure because it controls how the kidneys handle salt and water, both of which play significant roles in regulating blood pressure levels,” he says. “The drug hasn’t been FDA-approved yet, but approval is widely expected by the end of the second quarter of 2026, so it could happen any day now.”
Who is most likely to be prescribed this new blood pressure medication?
Patients with hard-to-control blood pressure will likely be first in line for this new medication, explains Dr. Freeman. “Patients taking three or more medications, including a diuretic, who still haven’t reached their target blood pressure are categorized as having ‘resistant’ hypertension, and they’re likely to be the first group prescribed this new drug.”
People taking one or two blood pressure medications who aren’t well-controlled could also be prescribed baxdrostat, he adds. “However, there are older, generic medications that are very inexpensive and may be tried first due to cost considerations.”
What is the price of baxdrostat?
While AstraZeneca hasn’t announced baxdrostat’s price, brand-name medications typically cost more than generics, so insurance companies may restrict access for patients on fewer than two to three medications, says Dr. Freeman. “For this reason, baxdrostat likely won’t be a first-line treatment for most patients.”
The potential exception? Patients who have small benign tumors on their adrenal glands that overproduce aldosterone. “For these individuals, baxdrostat is likely to be an excellent first-line choice,” notes Dr. Freeman.
However, he says that it may require specific FDA approval for this condition before insurers will cover the cost. That approval will likely come only after a large ongoing study proves the drug’s efficacy and safety for this group.
“A small study published in the New England Journal of Medicine, of which I am a co-author, suggests baxdrostat is quite effective in these individuals. This group represents about 10 percent of people with hypertension—millions of people worldwide. Many aren’t diagnosed with this problem and struggle to control their blood pressure, but baxdrostat’s approval is likely to encourage greater efforts to identify them, since early trials show it works so well.”
1 important potential side effect of baxdrostat
The major side effect that needs to be monitored is potassium retention in the blood, explains Dr. Freeman. “This relates to how aldosterone works—it directs the kidneys to hold on to sodium while secreting potassium into the urine. When you block aldosterone production, which is what baxdrostat does, you get the opposite response: sodium is secreted and potassium is retained.”
If potassium rises above normal levels, it’s called hyperkalemia (K is the chemical symbol for potassium). While this is relatively rare, it’s more likely in people with impaired kidney function, so physicians will monitor potassium levels with periodic blood tests, particularly in patients with any kidney dysfunction.
The good news? This problem can usually be managed by reducing dietary potassium and pairing baxdrostat with other blood pressure medications that lower potassium levels.
How will it be used with other medications?
Baxdrostat will likely be used alongside standard generic drugs that have been around for decades, called ACE inhibitors or angiotensin receptor blockers (ARBs), notes Dr. Freeman. Examples include enalapril (an ACE inhibitor) and valsartan (an ARB), though there are many versions of each with different generic names.
“I would use those older medications first in someone just starting their first blood pressure treatment, as they work well and are very inexpensive,” he says. “But for anyone on three or more medications whose blood pressure is poorly controlled—and they’re clearly taking the medications as prescribed—I would consider baxdrostat as my first choice once it’s formally approved.”
One important caveat: Physicians need to ensure the patient doesn’t have significant kidney problems or other conditions that predispose them to hyperkalemia before prescribing baxdrostat.
The bottom line on baxdrostat for hypertension
Baxdrostat offers new hope for people with resistant hypertension who haven’t reached their blood pressure goals despite taking multiple medications. While FDA approval is expected soon, it likely won’t be a first-line treatment due to cost. But for those struggling on three or more medications, it could be a game-changer. The key is working with your doctor to determine if it’s right for you, especially if you have kidney issues that require careful potassium monitoring.
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