LANCET BAX24

What is the full Bax24 article title?

Effect of baxdrostat on ambulatory blood pressure in patients with resistant hypertension (Bax24): a phase 3, randomised, double-blind, placebo-controlled trial.

Who were lead authors on the Bax24 Lancet article?

Prof Michel Azizi and Jenifer M Brown are listed among the lead authors.

What journal and issue published Bax24?

The Lancet, Volume 407, Issue 10532, pages 988-999, published March 7, 2026.

What was the DOI?

10.1016/S0140-6736(25)02549-8

What was Bax24 designed to test?

Whether baxdrostat 2 mg once daily lowers 24-hour ambulatory systolic blood pressure versus placebo in confirmed resistant hypertension.

Why is 24-hour ambulatory BP important?

It captures blood pressure across a full day and night, helping confirm true resistant hypertension beyond office readings.

What drug class is baxdrostat?

A selective aldosterone synthase inhibitor, designed to reduce aldosterone production.

What hormone does baxdrostat target indirectly by blocking its synthesis?

Aldosterone.

What is the simple sales-style mechanism explanation?

Baxdrostat turns down aldosterone production at the source instead of only blocking aldosterone’s downstream effects.

What patient population was studied?

Adults with resistant hypertension on background antihypertensive therapy.

How many patients were randomized?

217 patients were randomized: 108 to baxdrostat and 109 to placebo.

How were patients assigned to treatment?

Participants were randomized 1:1 to baxdrostat 2 mg once daily or placebo.

What phase was Bax24?

Phase 3.

What type of study was Bax24?

Randomised, double-blind, placebo-controlled, parallel-group trial.

How long was the double-blind treatment period?

12 weeks.

What dose was studied?

Baxdrostat 2 mg orally once daily.

What happened before randomization?

A single-blind placebo run-in was used before randomization.

What was a key seated office SBP criterion?

Seated office SBP had to be elevated despite antihypertensive therapy; reports describe a range of 140 to <170 mmHg.

What was a key ambulatory SBP criterion?

Participants had confirmed ambulatory 24-hour average SBP of at least 130 mmHg at baseline.

What background therapy did patients have?

Patients were on at least three antihypertensive medications, including a diuretic, at optimized doses.

What was the primary endpoint?

Change from baseline to Week 12 in 24-hour average ambulatory systolic blood pressure.

What was the baxdrostat 24-hour ambulatory SBP change?

Baxdrostat reduced 24-hour ambulatory SBP by 16.6 mmHg from baseline at Week 12.

What was the placebo 24-hour ambulatory SBP change?

Placebo reduced 24-hour ambulatory SBP by 2.6 mmHg from baseline at Week 12.

What was the placebo-adjusted 24-hour ambulatory SBP reduction?

The placebo-adjusted reduction was 14.0 mmHg in favor of baxdrostat.

Was the primary endpoint statistically significant?

Yes. The 24-hour ambulatory SBP reduction versus placebo was statistically significant with p<0.0001.

What was the 95% CI for the primary endpoint?

The 95% CI was -17.2 to -10.8 mmHg.

What happened to night-time ambulatory SBP?

Night-time ambulatory SBP showed a placebo-adjusted reduction of 13.9 mmHg with baxdrostat.

What was the 95% CI for night-time ambulatory SBP?

The 95% CI was -17.5 to -10.3 mmHg.

Was the night-time SBP result significant?

Yes. p<0.0001.

What happened to seated SBP?

Seated SBP showed a placebo-adjusted reduction of 10.3 mmHg with baxdrostat.

What was the 95% CI for seated SBP?

The 95% CI was -14.9 to -5.6 mmHg.

Was the seated SBP result significant?

Yes. p<0.0001.

What percent achieved 24-hour average SBP under 130 mmHg with baxdrostat?

About 71% of baxdrostat-treated patients achieved 24-hour average SBP below 130 mmHg.

What percent achieved 24-hour average SBP under 130 mmHg with placebo?

About 17% of placebo-treated patients achieved 24-hour average SBP below 130 mmHg.

What was the odds ratio for achieving 24-hour SBP under 130 mmHg?

The odds ratio was 15.2 in favor of baxdrostat.

What was the 95% CI for that odds ratio?

The 95% CI was 6.6 to 35.2.

What happened to 24-hour ambulatory DBP?

Reports described a placebo-adjusted 24-hour ambulatory DBP reduction of 6.8 mmHg with baxdrostat.

What were the 24-hour ambulatory DBP changes by arm?

Baxdrostat reduced 24-hour ambulatory DBP by 8.3 mmHg versus 1.5 mmHg with placebo.

How was overall tolerability described?

Baxdrostat was generally well tolerated, with no new safety signals reported.

What safety issue should be watched mechanistically?

Hyperkalaemia/hyperkalemia is an expected monitoring concern with aldosterone-lowering therapy.

What is the simplest one-sentence Bax24 takeaway?

In confirmed resistant hypertension, baxdrostat 2 mg significantly lowered true 24-hour ambulatory SBP by 14 mmHg more than placebo at 12 weeks.

Why is Bax24 persuasive clinically?

It used ambulatory BP monitoring, showed strong day-and-night BP lowering, and had a large difference in patients reaching <130 mmHg 24-hour SBP.

How should you explain the trial in 10 seconds?

Bax24 proved baxdrostat 2 mg lowered round-the-clock BP in resistant hypertension: 14 mmHg better than placebo on 24-hour SBP and 71% reached <130 mmHg versus 17% on placebo.

What should you avoid overstating?

Do not claim outcomes benefits like fewer MIs, strokes, kidney failure events, or mortality from Bax24; it was a BP endpoint trial.