Overview

This is a Phase III, multicentre, randomised, double-blind, placebo-controlled, parallel-group study to evaluate the safety, tolerability, and efficacy of baxdrostat versus placebo, on the reduction of Seated Blood Pressure (SBP) and unsuppression of Plasma Renin Activity (PRA) in approximately 180 participants ≥ 18 years of age with Primary Aldosteronism (PA), with or without prior treatment with Mineralocorticoid Receptor Antagonists (MRAs) or potassium-sparing diuretics.

Baxdrostat (or placebo) will be administered once daily, up-titrated after 2 weeks to based on clinical response and tolerability. The study is planned to be conducted globally in approximately 90 study centres and approximately 12 countries.

Eligibility

Inclusion Criteria:

• Male or female participants must be ≥ 18 years of age
• Participants with a documented diagnosis of PA that fulfils the criteria defined in the 2016 or 2025 Endocrine Society Guidelines.
• Participants willing and able to cease dosing of MRA orpotassium sparing diuretics per study requirement for participantstaking an MRA or potassium sparing diuretic at Screening.
• eGFR ≥ 45 mL/min/1.73m2 at Screening
• Serum potassium level ≥ 3.0 and < 5.0 mmol/L at Screeningdetermined as per the central laboratory.
• Have a stable regimen of antihypertensive medications for at least 4 weeks prior to randomisation
• Mean seated SBP on AOBPM of ≥ 135 mmHg.

Exclusion Criteria:

• If not taking an MRA or potassium sparing diuretic at Screening: Mean seated SBP > 170 mmHg or mean seated DBP ≥110 mmHg (on AOBPM).

If taking an MRA or potassium sparing diuretic at Screening: Mean seated SBP > 160 mmHg or mean seated DBP ≥ 100 mmHg.

• Previous surgical intervention for an adrenal adenoma or have a planned adrenalectomy, renal nerve denervation, or adrenal ablative procedure during the course of the study.
• Has the following known secondary causes of HTN: renal artery stenosis, uncontrolled or untreated hyperthyroidism, uncontrolled or untreated hypothyroidism, pheochromocytoma, Cushing's syndrome, aortic coarctation.
• Serum sodium level < 135 mmol/L at Screening, determined as per central laboratory.
• New York Heart Association functional HF class IV at Screening.
• Persistent atrial fibrillation.
• Treatment with any MRA or potassium-sparing diuretic within 2weeks prior to Randomisation.