A new daily pill for high blood pressure is set to revolutionise treatment for the first time in decades, experts have said.
The wonder drug, baxdrostat, is the first in a new class of treatments and has been hailed as a “game-changer” for people with high blood pressure.
It is the first drug to precisely target and suppress a specific hormone, aldosterone, which scientists say is the “core problem”.
In a landmark trial, baxdrostat was given to patients whose elevated blood pressure was “uncontrolled” or “resistant” and had not responded to other medicines.
The pill slashed patients’ seated systolic blood pressure – the higher of the two numbers on a reading – by around 10mmHg compared with placebo, in results unveiled at the European Society of Cardiology’s annual conference in Madrid.
What is considered to be a healthy blood pressure level?
About four in 10 patients taking the drug reached a healthy blood pressure level – which is typically considered under 130mmHg – compared with fewer than two in 10 taking a placebo. The patients in the trial had previously failed to get a grip on the condition, which can lead to fatal heart disease if untreated.
Prof Bryan Williams of University College London, who led the trial and is chief medical officer of British Heart Foundation, said he had “never seen anything like it” as he hailed the results as “unprecedented”.
“That is a big drop in blood pressure. That would reduce [the chance of a] stroke by about 40 per cent and heart disease by about 25 per cent,” he said.
“It’s just amazing. I’ve never seen anything like it. The reductions in 24-hour average blood pressure were 15 to 17mmHg. So we may be even underestimating the effect in the clinic, and actually over the whole 24 hour period the effect was huge.”
The drug also produced a significant fall that lasted during the participants’ sleep, which Prof Williams said suggested the benefits of the pill were long-lasting.
Patients experienced benefits within four weeks and up to 32 weeks – the trial’s duration. Some of the benefit also remained within eight weeks after stopping the drug.
Some 14 million Britons suffer from high blood pressure, also called hypertension, and millions could be set to benefit from the new drug.
‘A triumph of scientific discovery’
It is understood that AstraZeneca, the manufacturer, is in the process of seeking regulatory approval for the drug, including in the UK, meaning it could be available on the NHS as soon as next year.
Baxdrostat works by blocking the production of aldosterone, which helps the kidneys regulate salt and water.
Some people produce too much aldosterone, which impacts levels of salt in the blood and increases their blood pressure. It increasingly becomes an issue with age.
With baxdrostat blocking the production of this hormone, scientists were able to directly address the “core problem” behind high blood pressure.
Prof Williams added: “Despite many treatments and a lot of discussion it’s still the single most important preventable cause of premature death globally.
“About 50 per cent of patients who are treated globally don’t reach the recommended treatment targets and this represents hundreds of millions of people.
“This drug development is really a triumph of scientific discovery.”
While it will initially only be licenced for hard-to-treat hypertension, in line with the latest clinical trial, baxdrostat could be expanded to become a “first-line” option in the future, if it is more effective than other treatments.
Paul Leeson, a professor of cardiovascular medicine and cardiologist at the University of Oxford, who was not involved in the trial, said the medicine was “one version of a new range of medications that work differently, and directly reduce the levels of aldosterone”.
He added: “Importantly, the trial was performed across several countries and included both men and women, as well as patients with different ethnic backgrounds. This helps ensure the findings are relevant to the range of patients we see with blood pressure problems.
“The reduction in blood pressure of 5 to 10mmHg is typically what we would expect for any drug or intervention we use to manage blood pressure. The medication also worked even when added on top of other tablets.”
Prof Leeson continued: “The trial did not test whether the drug reduces your chance of a heart attack or stroke, but we would expect a benefit based on how it effects the blood pressure.
“This new type of medicine may therefore be a potentially valuable additional treatment to tackle high blood pressure.”
The results were published in the New England Journal of Medicine.
In a separate study presented at the European Society of Cardiology Congress, researchers found that cholesterol-fighting injection inclisiran helped 85 per cent of patients get their cholesterol under control within 90 days.