2) You've already seen those data w/@PamTaubMD & u can still earn 🆓credit by checking out https://t.co/Jnm3I9eari. Now we take a look at those data through the eyes of our favorite #nephrology expert & prolific author, Edgar Lerma @edgarvlermamd 🇵🇭.#nephtwitter #MedEd #nephX pic.twitter.com/rkPYKaxLc4
— cardio-met (@cardiomet_CE) November 3, 2025
4a) So let's ✅what u know!
— cardio-met (@cardiomet_CE) November 3, 2025
1⃣ Which statement best reflects the global impact of poorly controlled #HTN?
A. It affects < 100 million adults worldwide
B. It is the leading preventable cause of #CV death
C. It mainly affects high-income countries
D. Global control rates > 60%
4c) 3⃣ In the #BaxHTN trial, how did #baxdrostat’s blood pressure #BP-lowering effect in pts with #CKD compare to those without CKD?
— cardio-met (@cardiomet_CE) November 3, 2025
A. Significantly less benefit in CKD
B. Similar benefit in both groups
C. Only effective in non-CKD
D. Increased adverse events, no benefit
6a) There are differences in terminology amongst the various guidelines around terms such as #resistant, #refractory, or #uncontrolled #HTN pic.twitter.com/yTyA1Otj8T
— cardio-met (@cardiomet_CE) November 3, 2025
6c) This term is broader than #resistant HTN; includes pts where control is possible but requires intensive management due to factors like suboptimal adherence, lifestyle challenges, frequent med changes, or exacerbating conditions (eg #obesity, sleep apnea, high salt intake).
— cardio-met (@cardiomet_CE) November 3, 2025
7) This matters in #nephrology, as
— cardio-met (@cardiomet_CE) November 3, 2025
👉#CKD pts have ⤵️BP targets & ⬆️complications w/uncontrolled BP
👉 Resistant/uncontrolled HTN accelerates kidney function loss
👉Definitions guide when to escalate tx, involve multidisciplinary teams, or look for treatable secondary causes.
8b) So still uncontrolled despite those PLUS often an #MRA = trouble, no matter what definition is used, as long as optimal or maximally tolerated doses and at the appropriate dosing frequency are in use
— cardio-met (@cardiomet_CE) November 3, 2025
9a) Using the definition of #resistant #HTN (let's call it #RH) in 6a ⤴️, in a cohort study of 205,750 pts with incident HTN, it was reported that the risk of CV outcomes was higher in patients with RH, with a hazard ratio of 1.47 (95% CI 1.33 to 1.62).
— cardio-met (@cardiomet_CE) November 3, 2025
🔓https://t.co/Kiy6ocqtcu pic.twitter.com/BsSfYmGEIF
10a) Pts with #RH have up to 50% increased risk of #CV events, 46% increased risk of #HF, 24% increased risk of ischemic cardiac events, 32% increased risk of #ESRD, 14% increased risk of #stroke, and 6% increased risk of premature death.
— cardio-met (@cardiomet_CE) November 3, 2025
10c) Pts with RH do have a higher prevalence of comorbid conditions, including #diabetes, #OSA, #CKD, ischemic heart disease, & stroke, which can themselves also greatly ⬆️CV morbidity and mortality
— cardio-met (@cardiomet_CE) November 3, 2025
10e) #RH is a complex pathophysiologic state with contributions from (1) sodium retention, (2) #aldosterone excess, (3) low #renin states, and (4) activation of the #RAAS. See https://t.co/RavEU42H19 pic.twitter.com/K70V8HVh8D
— cardio-met (@cardiomet_CE) November 3, 2025
11b) #Aldosterone excess is related to being overweight or obese, as adipocytes can directly secrete aldosterone or indirectly stimulate the release of aldosterone secretagogues.
— cardio-met (@cardiomet_CE) November 3, 2025
This can lead to further sodium & fluid retention.https://t.co/3YS2vlkpqw
11d) The combination of low renin and #aldosterone #dysregulation is common, resulting in resistant HTN:
— cardio-met (@cardiomet_CE) November 3, 2025
🔓https://t.co/pqr6ex9ZI0 pic.twitter.com/aNx3wxOhn4
12b) #Spironolactone has been shown to be the best 4th line agent at reducing #BP in pts with #RH, as shown in the Prevention & Treatment of Hypertension With Algorithm based therapY-2 (PATHWAY-2) trial.
— cardio-met (@cardiomet_CE) November 3, 2025
🔓 https://t.co/N5XLNjg70q#VisualAbstract by @ChristianMuM @NephJC pic.twitter.com/qTG9ey9mPD
12d) cont
— cardio-met (@cardiomet_CE) November 3, 2025
👉Hypotension, falls, bradycardia (~4-5%)
👉 #Gynecomastia ♂️, menstrual irregularities ♀️, ⬇️libido, & sexual dysfunction, esp w/long-term use.
Laboratory monitoring (K+, Na+, renal function) is warranted for pts taking #spironolactone.
See 🔓https://t.co/XmQdWn8uXQ
13b) Check out this stepwise evaluation and nonpharmacologic therapy to management of #RH from @asnpublications @MRrenaldoc
— cardio-met (@cardiomet_CE) November 3, 2025
🔓 https://t.co/hS2sfOS3Ke pic.twitter.com/4qPgGUOQ3A
15) Check out this nice discussion on #NephMadness 2025: Resistant Hypertension Region from @jordy_bc @stephanietr612
— cardio-met (@cardiomet_CE) November 3, 2025
🔓 https://t.co/mZhiQ24JZr pic.twitter.com/1z9EUyGZSB
16b) cont:
— cardio-met (@cardiomet_CE) November 3, 2025
– Dual endothelin antagonists
– Aldosterone synthetase inhibitors #ASIs
– Atrial natriuretic peptide #ANP inhibitors
– Attenuators of hepatic #angiotensinogen pic.twitter.com/vQgXN9eRrU
18a) As above, esp in pts with low serum #renin, #aldosterone dysregulation plays an important pathogenic role in difficult-to-control #HTN
— cardio-met (@cardiomet_CE) November 3, 2025
In an attempt to bypass the aldosterone escape effect, aldosterone synthase became a target of interest
See 🔓https://t.co/AjCJqObrd8
19a) #BrigHTN was a phase 2 trial conducted at community-based practices in 🇺🇸
— cardio-met (@cardiomet_CE) November 3, 2025
🗒️It excluded patients with #BP > 180/110 mm Hg, #eGFR < 45 mL/minute/1.73m2, and uncontrolled #diabetes.#VisualAbstract by @krithicism @Nephmadness
🔓https://t.co/7Mq3Oo0380 pic.twitter.com/vMVhKE23WD
19c) Adverse events included
— cardio-met (@cardiomet_CE) November 3, 2025
– urinary tract infections #UTI
– headache
– fatigue
– #hyperkalemia, but potassium levels normalized with dietary management, & pts were able to complete the trial
Importantly, there were NO instances of #adrenocortical insufficiency.
20b) This def caught #nephrology attention, as almost immediately @ckd_ce author @brian_rifkin put out this nice #NephJC short and #VisualAbstract @NephJC
— cardio-met (@cardiomet_CE) November 3, 2025
🔓https://t.co/flneZ6aPk3 pic.twitter.com/y6NO510l2a
21b) After a 2-week single-blind run-in period in which patients received placebo in addition to their stable background medications, those who had a seated #SBP ≥ 135 mm Hg & had good adherence to background antihypertensive therapy were randomized. pic.twitter.com/dlnuLZar0k
— cardio-met (@cardiomet_CE) November 3, 2025
22b) A total of 796 patients underwent randomization
— cardio-met (@cardiomet_CE) November 3, 2025
– 1-mg baxdrostat (264 patients)
– 2-mg baxdrostat (266 patients), or
– Placebo (264 patients) in addition to background therapy.
🔓 https://t.co/qMQdiHNvmX pic.twitter.com/iddpRnAXgH
22d) Part 3 (weeks 24 to 32): double blind, randomized-withdrawal phase.
— cardio-met (@cardiomet_CE) November 3, 2025
🔓 https://t.co/qMQdiHNvmX pic.twitter.com/6ZRcHk4evB
23a) The primary efficacy endpoint was the change in the seated SBP from baseline to week 12, for each #baxdrostat group as compared with placebo.
— cardio-met (@cardiomet_CE) November 3, 2025
🔓 https://t.co/qMQdiHNvmX pic.twitter.com/Caoo58SUDc
23c) At start of 8wk randomized withdrawal period, mean seated SBP for pts who had been randomly assigned to receive 2-mg #baxdrostat or placebo was 133 mm Hg. pic.twitter.com/m1Zdza18yR
— cardio-met (@cardiomet_CE) November 3, 2025
25a) ATTN #nephrons! The mean change in the estimated glomerular filtration rate #eGFR from baseline to week 12 was –7.0±12.8 ml/minute/1.73 m2 of BSA with 1-mg #baxdrostat, –6.9±12.4 ml/min/1.73 m2 with 2-mg baxdrostat, and –0.1±8.6 ml per minute per 1.73 m2 with placebo.
— cardio-met (@cardiomet_CE) November 3, 2025
26a) And more for #nephtwitter: pts with #CKD were specifically studied in #FigHTN, published in @asnpublications: Ph 2 trial assessing #baxdrostat in participants with CKD & uncontrolled #HTN.
— cardio-met (@cardiomet_CE) November 3, 2025
See 🔓https://t.co/HxHHWvrgj6 pic.twitter.com/Lz3v8hHqSN
26c) And importantly, #baxdrostat may reduce #albuminuria versus placebo
— cardio-met (@cardiomet_CE) November 3, 2025
🔓 https://t.co/HxHHWvrgj6 pic.twitter.com/YlRNBacXfR
26c-additional re reduced albuminuria with #baxdrostat pic.twitter.com/a6nSzTo5kt
— cardio-met (@cardiomet_CE) November 3, 2025
27) So—TOPLINE#BaxHTN: What matters?#ESCCongress #ESC25 pic.twitter.com/fxpDHdMqfP
— cardio-met (@cardiomet_CE) November 3, 2025
29a) Finally, more from the #nephrology community to #BaxHTN: [they] have broadly welcomed the results, viewing the data as a meaningful advance in tx of uncontrolled/resistant HTN, though w/cautious optimism pending long-term renal & #CV outcomes. 🔓 https://t.co/Mp4kZsWAr8
— cardio-met (@cardiomet_CE) November 3, 2025
29c) @ERAkidney released a brief statement in early September 2025 describing #BaxHTN results as “a promising step forward in the pathophysiological targeting of aldosterone synthesis for resistant hypertension” . . .
— cardio-met (@cardiomet_CE) November 3, 2025
29e) @ASNKidney commended the #BaxHTN trial for “the methodological depth and global recruitment scale” and called the drug “the first molecule to make aldosterone synthase inhibition clinically viable.”
— cardio-met (@cardiomet_CE) November 3, 2025
🔓 https://t.co/Hq0qqgRHSc
29g) Meanwhile, #nephrologist Jamie P Dwyer @UofUHealth called #baxdrostat “a one-two punch to kidney disease and hypertension” while @jordy_bc called it called “potentially a game changer” for #CKD patients with uncontrolled HTN.
— cardio-met (@cardiomet_CE) November 3, 2025
31) And YOU 🫵must be ready too–ready to claim 1.0hr 🆓CE/#CME credit! Just point your 🖱️to https://t.co/FzQD2D84CO and you'll get your certificate! Many 🙏to @edgarvlermamd for taking us through this!
— cardio-met (@cardiomet_CE) November 3, 2025