Presentation (CTI)

OBJECTIVES: Persistently uncontrolled hypertension (HTN) remains a major public health challenge across Europe and contributes to cardiovascular (CV), renal, and neurocognitive morbidity and mortality. However, current HTN models focus on a limited set of outcomes, underestimating disease burden and the value of treatment. We assessed the impact of adding baxdrostat, a first-in-class selective aldosterone synthase inhibitor, to standard-of-care (SoC) versus SoC alone in patients with uncontrolled HTN in Germany, Spain, and the UK over a lifetime horizon.
METHODS: Alongside major adverse CV events (MACE: CV death, non-fatal myocardial infarction and non-fatal stroke), the BAX-HTN model, a patient-level microsimulation model, captures incidence and progression of chronic kidney disease (CKD) and neurocognitive outcomes (mild cognitive impairment and dementia). Baseline clinical inputs were aligned to clinical trial data; patient characteristics were predominantly derived from country-specific real-world evidence (RWE) for uncontrolled HTN patients receiving ≥2 antihypertensives. Outcome risks were modified by treatment effects on office blood pressure (BP), 24-hr BP, and urinary albumin-creatinine ratio (uACR). Treatment duration assumptions were informed by literature, RWE, and expert opinion.
RESULTS: Over a lifetime horizon, baxdrostat was predicted to prolong time to MACE (incremental: 0.99-1.80 years) and increase average time spent free from any clinical event (incremental: 0.22-0.65 years). CKD onset and neurocognitive events were delayed by 0.92-1.15 years and 0.41-0.64 years, respectively. Relative reductions in CV mortality were 3.8%, 1.3%, and 3.9% in Germany, Spain, and the UK, respectively. Predicted benefits varied across countries, reflecting differences in baseline risk.
CONCLUSIONS: By capturing diverse outcomes within a single framework, the Bax-HTN model provides a more comprehensive assessment of the consequences of uncontrolled HTN. Our findings suggest baxdrostat may reduce the holistic burden of HTN within payer- and patient-relevant time horizons. Between-country differences in projected benefits highlight the importance of local epidemiology when evaluating new therapies.