How does baxdrostat work to lower blood pressure in hard-to-treat patients. What were the results of the clinical trial for this experimental drug. Who might benefit from baxdrostat as a potential new hypertension treatment.

Understanding Baxdrostat: A Novel Approach to Treating Resistant Hypertension

Baxdrostat represents a potential breakthrough in the treatment of resistant hypertension, a condition where blood pressure remains high despite the use of multiple medications. This experimental drug works by targeting aldosterone, a hormone that plays a crucial role in blood pressure regulation.

Aldosterone causes the body to retain salt, which in turn increases blood volume and raises blood pressure. By preventing the production of aldosterone, baxdrostat addresses a key mechanism behind treatment-resistant hypertension.

How does baxdrostat differ from existing hypertension treatments?

Unlike many conventional blood pressure medications that focus on dilating blood vessels or reducing fluid retention, baxdrostat tackles the root cause of hypertension in some patients – excessive aldosterone production. This unique approach makes it particularly promising for those who have not responded well to standard therapies.

Clinical Trial Results: Promising Outcomes for Hard-to-Treat Patients

The recent clinical trial of baxdrostat, published in The New England Journal of Medicine, offers encouraging results for patients with treatment-resistant hypertension. The study involved 248 participants who had unsuccessfully managed their blood pressure with at least three different medications.

What were the key findings of the baxdrostat trial?

• Patients receiving the highest dose (2 mg) saw an average systolic blood pressure reduction of 20 points
• The 1 mg dose group experienced an average decrease of 17.5 points
• Even the lowest dose (0.5 mg) resulted in an average reduction of 12 points
• Many patients moved from stage 2 hypertension to stage 1 hypertension after treatment

These results are particularly significant given the challenging nature of treatment-resistant hypertension. For many patients in this category, achieving any meaningful reduction in blood pressure can be a struggle.

The Impact of Baxdrostat on Blood Pressure Management

The potential of baxdrostat to significantly lower blood pressure in hard-to-treat patients could revolutionize hypertension management. Currently, patients with resistant hypertension often require complex medication regimens involving multiple drugs, which can be difficult to manage and may lead to side effects or poor adherence.

Could baxdrostat simplify treatment for some hypertension patients?

If approved, baxdrostat could offer a simpler solution for some patients. The study suggests that a single pill of baxdrostat might achieve what previously required multiple medications. This could lead to improved patient compliance and potentially better overall blood pressure control.

Safety Profile and Side Effects of Baxdrostat

While the efficacy results of baxdrostat are promising, understanding its safety profile is crucial. The clinical trial provided valuable insights into the potential side effects and risks associated with the drug.

What side effects were observed during the baxdrostat trial?

• 44% of patients experienced side effects, most of which were mild
• Common side effects (occurring in at least 5% of patients) included:
  • Urinary tract infections
  • Elevated potassium levels
  • Headache
  • Fatigue
• Eight patients experienced serious side effects, including:
  • Dangerously low blood pressure
  • Abnormally low sodium levels
  • Unusually high potassium levels

While these side effects warrant careful consideration, it’s important to note that many were mild and manageable. However, the occurrence of serious side effects in a small number of patients highlights the need for close monitoring during treatment.

The Science Behind Baxdrostat: Targeting Aldosterone Production

To fully appreciate the potential of baxdrostat, it’s essential to understand its mechanism of action. The drug’s ability to suppress aldosterone production is at the heart of its effectiveness in treating resistant hypertension.

How does baxdrostat affect aldosterone levels in the body?

Baxdrostat works by inhibiting an enzyme crucial to the production of aldosterone. By doing so, it effectively reduces the amount of aldosterone circulating in the blood and excreted in urine. This reduction in aldosterone levels leads to decreased salt retention and, consequently, lower blood pressure.

The study demonstrated that baxdrostat successfully suppressed both blood and urine levels of aldosterone, confirming its mechanism of action. This targeted approach is particularly beneficial for patients with excessive aldosterone levels, who often struggle to control their blood pressure with conventional treatments.

Potential Impact on Hypertension Treatment Landscape

If baxdrostat continues to show promise in further clinical trials and ultimately gains regulatory approval, it could significantly impact the treatment landscape for hypertension, especially for those with resistant forms of the condition.

How might baxdrostat change the approach to treating resistant hypertension?

The introduction of baxdrostat could lead to a more personalized approach to hypertension treatment. Patients with high aldosterone levels or those who have not responded well to traditional therapies might be identified as candidates for baxdrostat treatment. This targeted approach could improve outcomes for a subset of patients who currently struggle to manage their blood pressure effectively.

Moreover, the potential for a single-pill solution could simplify treatment regimens, potentially improving patient adherence and quality of life. This is particularly significant given the chronic nature of hypertension and the importance of consistent, long-term management.

Future Research and Development of Baxdrostat

While the results of this clinical trial are encouraging, it’s important to note that baxdrostat is still in the experimental stages. The study discussed represents the second of three phases typically required for U.S. regulatory approval.

What are the next steps in the development of baxdrostat?

The next phase of research will likely involve larger-scale clinical trials to further evaluate the drug’s efficacy and safety profile. These studies will help determine the optimal dosing regimen, identify any rare side effects, and assess the long-term effects of baxdrostat treatment.

Additionally, comparative studies may be conducted to directly compare baxdrostat with existing hypertension treatments. This will help healthcare providers understand where baxdrostat fits within the current treatment landscape and which patients are most likely to benefit from its use.

Implications for Patients with Treatment-Resistant Hypertension

For patients struggling with treatment-resistant hypertension, the development of baxdrostat offers a ray of hope. This condition can be frustrating and potentially dangerous, as persistently high blood pressure increases the risk of serious health complications.

Who might benefit most from baxdrostat if it becomes available?

Baxdrostat could be particularly beneficial for:

• Patients who have not achieved target blood pressure levels despite using multiple medications
• Individuals with high aldosterone levels
• Those experiencing significant side effects from current hypertension medications
• Patients seeking a simpler treatment regimen

While it’s important not to overstate the potential of an experimental drug, the results of this study provide reason for cautious optimism. For many patients with treatment-resistant hypertension, even a modest improvement in blood pressure control could have significant health benefits.

The Broader Context: Addressing the Global Hypertension Challenge

The development of baxdrostat is set against the backdrop of a global health challenge. Hypertension affects millions of people worldwide and is a leading risk factor for cardiovascular disease, stroke, and other serious health conditions.

How significant is the problem of treatment-resistant hypertension?

Treatment-resistant hypertension affects a substantial subset of hypertensive patients, with estimates suggesting it occurs in 10-20% of those diagnosed with high blood pressure. This translates to millions of individuals worldwide who struggle to control their blood pressure despite medical intervention.

The potential introduction of a new class of hypertension medication, represented by baxdrostat, could have far-reaching implications for public health. By providing an effective option for those who don’t respond to current treatments, it could help reduce the overall burden of cardiovascular disease and related complications.

Conclusion and Future Outlook

The development of baxdrostat represents an exciting advance in the field of hypertension treatment. Its novel mechanism of action, targeting aldosterone production, offers a new approach to managing blood pressure in patients who have not responded well to existing therapies.

While the results of this clinical trial are promising, it’s important to maintain a balanced perspective. Further research is needed to fully understand the long-term efficacy and safety of baxdrostat. If it continues to show positive results and gains regulatory approval, baxdrostat could become a valuable addition to the hypertension treatment arsenal.

For patients with treatment-resistant hypertension, the development of baxdrostat offers hope for better blood pressure control and improved health outcomes. As research progresses, it will be crucial to monitor the drug’s performance in larger and more diverse patient populations.

Ultimately, the goal of developing new treatments like baxdrostat is to improve patient care and outcomes. By providing more options for managing hypertension, especially in difficult-to-treat cases, we move closer to effectively controlling this widespread and potentially dangerous condition.

New Drug May Lower Blood Pressure In Hard-to-Treat Patients

The experimental drug baxdrostat may help hypertension patients who can’t sufficiently reduce their blood pressure with other medications.

By Lisa Rapaport

November 11, 2022

Fact-Checked

Patients with excessive aldosterone levels in the blood are resistant to treatment with commonly used drugs for hypertension.
Canva

Some people with uncontrolled high blood pressure who can’t manage the condition effectively with typical multidrug treatment regimens might one day achieve this goal with a single pill, a new study suggests.

The early-stage study included 248 people with what’s known as treatment-resistant hypertension, who had unhealthy blood pressure levels despite taking at least three different medications to manage the condition. Participants were randomly assigned to take either a placebo or a 0.5-, 1-, or 2-milligram (mg) dose of the experimental drug baxdrostat.

After 12 weeks of treatment, patients on the highest baxdrostat dose saw their systolic blood pressure — the “top number” that shows how much pressure blood exerts against artery walls when the heart beats — drop by an average of 20 points, according to study results published in the The New England Journal of Medicine.

“The results of this first-of-its-kind drug are exciting, although more testing is required before we can draw comparisons with any existing medications,” co-senior study author Morris Brown, MD, a professor of endocrine hypertension at Queen Mary University of London, said in a statement.

“But baxdrostat could potentially offer hope to many people who do not respond to traditional hypertension treatment,” Dr. Brown added.

Baxdrostat also worked at lower doses, although with less dramatic results. Systolic blood pressure declined by an average of 17.5 points with the 1 mg dose and by about 12 points on average with the 0.5 mg dose.

At the start of the study, most patients had average systolic blood pressure levels over 140 millimeters of mercury (mmHg), which is classified as stage 2 hypertension by the American Heart Association (AHA). Doctors often prescribe a combination of several different blood pressure medications and lifestyle changes like improved eating and exercise habits.

By the end, many of the patients on baxdrostat reduced their systolic blood pressure levels enough to be classified with either stage 1 hypertension — a range from 130 mmHg to 139 mmHg.

A total of 44 percent of patients in the study experienced side effects, most of which were mild. The most common side effects, occurring in at least 5 percent of patients, were urinary tract infections, elevated potassium levels, headache, and fatigue. Eight patients experienced serious side effects, including dangerously low blood pressure, abnormally low sodium levels, and unusually high potassium levels.

Baxdrostat works by preventing the body from making aldosterone, a hormone that can cause salt to be retained in the body, driving up blood pressure. Patients with excessive aldosterone levels in the blood are resistant to treatment with the commonly used drugs for hypertension. Baxdrostat suppressed blood and urine levels of aldosterone.

The study results were from the second of three phases of clinical trials typically required for U.S. regulatory approval. CinCor Pharma supported the trial and employed several researchers involved in the study.

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Pediatric Low Blood Pressure (Hypotension)

Pediatric Low Blood Pressure (Hypotension)

Hypotension, also called low blood pressure, happens when blood pressure falls below the normal range.

What is Pediatric Low Blood Pressure (Hypotension)?

Normal blood pressure is between 90/60 and 130/80.

• The top number, or systolic pressure, is a measurement of the pressure in the arteries when the heart muscle contracts.
• The bottom number, or diastolic pressure, is a measurement of the pressure in the arteries between beats of the heart.

Hypotension, or low blood pressure, happens when your child’s blood pressure falls below the normal range. A drop in blood pressure is not always a cause for concern, and the severity of the situation depends on the cause.

What are the different types of Pediatric Low Blood Pressure (Hypotension)?

Three main types of low blood pressure in children include:

Neurally mediated hypotension

This type of low blood pressure primarily affects children, and they usually outgrow it by adulthood. The blood pressure drop happens when a child has been standing for a long time. 

Orthostatic hypotension

This type of low blood pressure occurs when a child sits or stands up suddenly. It is a common reason for a drop in blood pressure and your child’s body will typically correct to normal blood pressure within a few seconds.

Severe hypotension

This life-threatening drop in blood pressure happens suddenly when a child has an infection, has an anaphylaxis allergic reaction or experiences a traumatic injury that causes sudden blood loss. When severe hypotension occurs, it prevents oxygen from getting to the brain and other organs, leading to serious problems or can even be fatal.

What are the signs and symptoms of Pediatric Low Blood Pressure (Hypotension)?

• Blurred vision
• Confusion
• Dizziness (vertigo)
• Fainting
• Feeling weak
• Nausea or vomiting
• Sleepiness

What are the causes of Pediatric Low Blood Pressure (Hypotension)?

The most common causes of low blood pressure in a child include:

• Anaphylaxis (life-threatening) allergic reaction
• Arrhythmia (abnormal heart rhythm)
• Certain medications, including painkillers and anti-anxiety medicines
• Dehydration
• Drinking alcohol (teenagers)
• Heart conditions
• Infection
• Sudden position change, such as standing up quickly

Pediatric Low Blood Pressure (Hypotension) Doctors and Providers

• Mouin Seikaly, MD

  Pediatric Nephrologist

• Soumya Adhikari, MD

  Pediatric Endocrinologist

• Chelsea Anderson, MD

  Pediatrician Newborn Medicine

• Michel Baum, MD

  Pediatric Nephrologist

• Elizabeth Brown, MD

  Pediatric Nephrologist

• Keri Drake, MD

  Pediatric Nephrologist

• Jyothsna Gattineni, MD

  Pediatric Nephrologist

• Halima Janjua, MD

  Pediatric Nephrologist

• Ximena Lopez, MD

  Pediatric Endocrinologist

• Jessica Morse, MD

  Pediatrician Newborn Medicine

• Raymond Quigley, MD

  Pediatric Nephrologist

• Joseph Schneider, MD

  Pediatrician Newborn Medicine

• Muraleedharan Sivarajan, MD

  Pediatrician Newborn Medicine

• Kaili Stehel, MD

  Pediatrician Newborn Medicine

• Smitha Vidi, MD

  Pediatric Nephrologist

• Matthias Wolf, MD

  Pediatric Nephrologist

• Sudha Mootha, MD

  Pediatric Endocrinologist

• Robin Landgraf, APRN, PNP-PC

  Nurse Practitioner – Nephrology

Low blood pressure – Hypotension, how to increase blood pressure? – Health World

What is low blood pressure?

Normal blood pressure ranges from 90/60 to 120/80 mmHg. If the pressure readings are less than 90/60, the pressure is considered low. This condition is called hypotension.

Each person has his own normal (working) pressure, so hypotension is usually called pressure, which is 20% lower than the working one. Many (most often thin women) live with hypotension for years and feel great. Doctors believe that these people are lucky – they are less likely to suffer from cardiovascular diseases.

Symptoms of low blood pressure

• Headache in the temples, sometimes headache in the back of the head or in the forehead is the most common symptom of low blood pressure. This symptom is directly related to circulatory disorders of the cerebral vessels.
• Dizziness, both sudden and after a sudden change in body position, especially in the morning, are also characteristic symptoms of low blood pressure. Usually dizziness is accompanied by darkening of the eyes, noise in the head, sometimes even fainting. Therefore, people with low blood pressure are not recommended to get out of bed abruptly.
• Feeling of weakness, fatigue, inactivity. Such people get tired very quickly, this is especially acute at the end of the working day – attention and memory decrease, the person becomes absent-minded, irritable, and he has mood swings. It is very difficult for them to be in the same position for a long time, for example, standing in line or washing dishes.
• Hypotension is often accompanied by vegetative disorders – sweating of the palms and feet, violations of thermoregulation – a decrease in temperature to 35.8 – 36 C, sometimes there may be a feeling of incomplete inspiration or shortness of breath during physical exertion.

What to do with low pressure?

If your blood pressure is consistently low but you feel good, there is no need to do anything. If you are concerned about nausea, dizziness or fainting, you need to consult a general practitioner in St. Petersburg.
The frequent occurrence of low blood pressure symptoms may indicate the presence of various diseases. In order to identify the cause, doctors conduct various examinations: ultrasound of the heart, blood vessels, ECG, FGDS. The therapist can refer to narrow specialists: a cardiac surgeon, a gastroenterologist, an endocrinologist, a neurologist. It is important to find out the true cause, because the method of treatment depends on the diagnosis.

General recommendations for hypotension:

• Drink plenty of fluids and salt. In summer, a person quickly loses water and minerals.
• Drink coffee, tea or cocoa. Drinks with caffeine give a good effect, though short-term.
• Avoid stuffiness, extreme stress or fright.
• Maintain a good mood.
• Perform simple exercises that are useful for hypotension: sit in a cross-legged position, clench and unclench your fists, work with a manual expander.

What to do if there is a sudden drop in pressure?

First, you need to take a supine position. If there is no way to lie down, you must definitely sit down and tilt your head as low as possible, between your knees. This position will ensure the flow of the required amount of blood to the brain and well-being will immediately improve.

Secondly, you should immediately drink a glass of water or, best of all, strong sweet tea. When fainting, you can revive him with a bottle of essential oils or ammonia. It is necessary to bring the bottle to the nose and lightly smear the whiskey. These measures will help in the shortest possible time to normalize blood pressure and bring a person back to normal.

Consequences of low blood pressure

• In children and adolescents, hypotension often occurs due to rapid growth, a malfunction occurs in the autonomic nervous system. As a result, when you change your posture or bend over, you get dizzy, fainting, which leads to injuries and accidents. In this case, physical activity is recommended – running, swimming, walking is better. Children usually outgrow the problem and hypotension goes away on its own.
• Hypotension in adulthood, especially in atherosclerosis, can cause ischemic stroke. In addition, with hypotension, angina pectoris and atherocardiosclerosis rapidly progress.
• Low blood pressure during pregnancy can even cause loss of the baby. Such expectant mothers should follow the doctor’s recommendations: walk more in the fresh air, have good sleep and nutrition.

Last update: 06/17/2021

Back

Low blood pressure: how to live with it?

Understanding how dangerous low blood pressure is and whether it is urgent to “raise” it.

What is low blood pressure, is it dangerous and how to turn it into normal – Oksana Dikur, a therapist and cardiologist at the Rassvet clinic, tells Women’sHealth readers.

What is low blood pressure anyway?

Blood pressure is the force with which blood presses against the walls of the arteries. At the moment when the heart contracts, the pressure is highest – it is called the upper, or systolic. In the interval between heartbeats, the pressure in the vessels drops – it is called lower, or diastolic.

Normal blood pressure ranges from 90/60 to 120/80 mmHg. The numbers 90 and 120 are systolic, and 60 and 80 are diastolic. If scores are less than 90/60, the pressure is considered low. This condition is called hypotension.

Is low blood pressure dangerous?

Many – most often thin women – live with hypotension for years and feel great. Doctors believe that these people are lucky: they are less likely to suffer from cardiovascular diseases.

However, if the pressure suddenly drops below normal levels, unpleasant symptoms may appear:

• blurred vision;
• dizziness;
• fainting;
• nausea or vomiting;
• drowsiness;
• feeling of weakness.

As a rule, at a young age, the health risk is not associated with low blood pressure itself, but with the reasons for which it falls. The exception is fainting. “This is the most alarming symptom, since it often leads to injuries and accidents,” says Oksana Dikur, internist, cardiologist at the Rassvet Clinic . – If hypotension is accompanied by loss of consciousness, you should definitely consult a doctor.

But for the elderly, lowering blood pressure can be really dangerous. Moreover, a drop in diastolic pressure is more dangerous than a decrease in systolic.

“This can lead to poor blood supply to the kidneys and brain, and increase the risk of stroke and kidney failure,” explains Oksana Dikur.

What causes hypotension?

If you suddenly change your body position

Get up quickly or, for example, sit up abruptly in bed. This is called orthostatic hypotension. When a person assumes a vertical position, blood rushes to the legs and abdomen under the influence of gravity, and the pressure in the vessels drops. In order to raise blood from the legs and normalize blood pressure, the autonomic nervous system increases the heart rate and constricts blood vessels.

Healthy people do not experience discomfort because this mechanism works very quickly. But in some cases, the autonomic nervous system fails. As a result, the pressure drops, the blood does not have time to rise from the legs, the brain lacks oxygen, and symptoms of hypotension appear. This happens, for example, in pregnant women, in people with certain diseases like diabetes, and in every fifth elderly person.

Sometimes healthy people experience similar sensations, for example, due to heat, and there is nothing to worry about. But if your head is spinning every time you change your posture, you need to see a doctor.

If you eat

After eating, the blood rushes to the gastrointestinal tract, and to prevent the pressure from dropping too much, the autonomic nervous system constricts the blood vessels and increases the heart rate. However, in about a third of older people, it cannot cope with such a load. This condition is called postprandial hypotension. If this happens, you need the help of a doctor.

If you grow too fast

As you might guess, the problem most often occurs in children and adolescents: due to rapid growth, a malfunction occurs in the autonomic nervous system. As a result, when changing posture or bending over, symptoms such as dizziness and fainting appear. This is called nerve-mediated hypotension. Children usually outgrow the problem, and hypotension goes away on its own.

But sometimes nerve-mediated hypotension is a sign of serious neurological diseases. In this case, a person needs the help of a doctor.

If you get sick

Blood pressure may drop in people who are dehydrated, those who have experienced shock, diabetics, patients with arrhythmia and heart failure. In this situation, doctors seek to cure or control the disease that leads to hypotension.

If you take certain medications

Sometimes hypotension is a side effect of anti-anxiety drugs, diuretics, pain relievers, or blood pressure pills. In order to solve the problem, the doctor, as a rule, only needs to adjust the dose of the medicine.

What if it is vegetovascular dystonia?

Vegetovascular dystonia is a non-existent diagnosis that people like to put on the territory of the former USSR. If the doctor is trying to write off low pressure on the IRR, it is worth finding another specialist who will find out why you are really unwell.

How to turn low blood pressure into normal?

If the pressure is constantly below normal, but you feel well, nothing needs to be done. If you are concerned about nausea, dizziness or fainting, you need to consult a doctor.

You can’t figure it out on your own: low blood pressure can be a symptom of a variety of diseases, and in order to find out the true cause, you need to take tests and undergo an examination. This is very important because the method of treatment depends on the diagnosis.

But there are also general recommendations that should be followed in case of hypotension:

Give up psychoactive substances

Alcohol, tobacco and smoking mixtures, which are used, for example, in hookahs, can lower blood pressure. In addition, drugs that are prescribed to the patient for completely different purposes sometimes have an effect on blood vessels. Therefore, if you are taking medications or dietary supplements, you must inform your doctor about them.

Drink plenty of fluids and salt

In summer, a person quickly loses water and minerals. An adequate amount of water significantly reduces the risk of developing hypotension.

Avoid situations that provoke hypotension

Blood pressure can drop due to stuffiness, extreme stress or fright, as well as standing for a long time, standing up abruptly, or eating very large meals.

Sit or lie down at the first sign of hypotension

Only get up if you feel better.

Wear compression stockings

This recommendation only applies to pregnant women. Your doctor will help you choose the right option.

Do simple exercises

Helpful for hypotension:

• sit cross-legged;
• strain the muscles of the arms, clenching and unclenching fists;
• to work with a manual expander.