Primary aldosteronism is a treatable hormonal cause of high blood pressure, but its usual management can involve long-term medication or surgery. A report published on 7 November says a Queen Mary University of London-led study in the New England Journal of Medicine found that extended aldosterone synthase inhibition (EASI), given for six to 12 months, was followed by sustained reductions in excess aldosterone and improved blood pressure in a small group of patients. The result is promising, not proof of a cure.

A hormonal cause hiding inside hypertension

Aldosterone is produced by the adrenal glands, which sit above the kidneys. It helps regulate the body's salt and water balance, but excess production can push the kidneys to retain sodium and water, expand blood volume and raise blood pressure. In primary aldosteronism, aldosterone production becomes at least partly independent of its usual regulation. The Endocrine Society describes the condition as an adrenal disorder that can affect one or both glands and is often underdiagnosed. The excess may arise from one adrenal gland or both, and that distinction can shape which treatment is appropriate.

That matters because a patient may be treated for hypertension for years without the hormonal driver being identified. The Endocrine Society's 2025 guideline suggests screening people with hypertension by measuring aldosterone and renin, calculating the aldosterone-to-renin ratio and checking potassium to help interpret the results. This is a screening recommendation, not a claim that most hypertension is caused by aldosterone: high blood pressure has many causes, and a positive screen requires clinical assessment.

Sources: Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline

Why targeting hormone production is different

Treatment for confirmed primary aldosteronism depends partly on whether excess production comes from one adrenal gland or both. For suitable patients with disease that is concentrated on one side, the Endocrine Society recommends considering removal of the affected gland. For people with bilateral disease, or those who do not undergo surgery, medication with mineralocorticoid receptor antagonists is a standard disease-specific option. These drugs block aldosterone's effects; they do not necessarily stop the adrenal glands from producing too much of the hormone.

Aldosterone synthase inhibitors take a different route by targeting the enzyme involved in making aldosterone. The proposed appeal of extended aldosterone synthase inhibition is that sustained suppression might do more than control the hormone while a tablet is being taken. The Queen Mary report links that idea to earlier laboratory work and to the possibility that prolonged treatment could alter aldosterone-producing tissue. That biological explanation remains a hypothesis to test, not a mechanism demonstrated by the 14-person follow-up alone. Baxdrostat is the compound named in the ELIXIR registry; the 2026 public summary does not identify the specific agent used by every participant in the earlier follow-up.

Sources: New treatment may cure common hormonal cause of high blood pressure · Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline · Baxdrostat and Molecular Imaging of Adrenal Cytoreduction in Primary Aldosteronism

What the 14-person follow-up reported

The Queen Mary-led report describes 14 people treated at eight centres in the United States with extended aldosterone synthase inhibition for six to 12 months. Researchers compared routine follow-up measurements of blood pressure and hormone levels with values recorded before treatment. The report says the biochemical marker used to track excess aldosterone production remained 99% lower than baseline after treatment had ended. It also describes partial or complete resolution of high blood pressure in some participants, with benefits observed for as long as two years.

According to the report, average blood pressure was 25 points lower than before treatment, and almost one quarter of participants had normal blood pressure without taking other medication. Those figures are notable because the improvement was reported after the treatment course had stopped, rather than only while participants were receiving a drug. The public summary does not specify the blood-pressure measure behind the 25-point figure, so this article does not relabel it as a systolic or diastolic change. The report also says hormone levels and blood pressure remained similar to, or lower than, the levels measured during treatment.

Sources: Hyperaldosteronism remission after extended aldosterone synthase inhibition · New treatment may cure common hormonal cause of high blood pressure

Why the findings need careful reading

Fourteen people are too few to establish how often the approach works, which patients might benefit, or whether the effect is durable across different forms of primary aldosteronism. The report describes an analysis of routine follow-up measurements and quotes lead researcher Morris Brown cautioning about the study's pragmatic nature. Its public summary does not describe a randomized comparison group or provide enough detail to assess selection effects, missing follow-up data or how representative the participants were. A strong signal can justify further study without proving a cure.

There is also a difference between the 15 participants in the earlier SPARK study of baxdrostat, published in the New England Journal of Medicine in 2025, and the 14 people described in the 2026 follow-up report. The available public summary does not explain the difference, so it should not be interpreted as evidence that one participant withdrew or was lost to follow-up. Nor does partial or complete improvement in some patients mean that all people with primary aldosteronism, or people with hypertension generally, would respond. The earlier SPARK report was a phase 2a study, an early clinical research stage, rather than a definitive comparison against standard treatment.

Sources: Hyperaldosteronism remission after extended aldosterone synthase inhibition · New treatment may cure common hormonal cause of high blood pressure · Phase 2a Study of Baxdrostat in Primary Aldosteronism

Existing diagnosis and treatment still matter

The 2025 Endocrine Society guideline recommends primary-aldosteronism-specific treatment rather than relying only on general blood-pressure medicines. It suggests unilateral adrenalectomy for patients with lateralizing disease who are suitable for surgery and want it, and mineralocorticoid receptor antagonists for people with bilateral disease or those who do not pursue surgery. It also suggests screening all people with hypertension for primary aldosteronism, while noting that implementation depends on resources, expertise and clinical context.

The new findings therefore do not justify replacing established diagnosis or treatment. Primary aldosteronism is assessed through blood tests that measure aldosterone and renin, with potassium helping clinicians interpret the results; additional testing may be needed to determine the source of excess hormone. People taking blood-pressure medication should not stop or change it because of a preliminary research report. Whether a patient should have surgery, take an antagonist or enter a clinical study is an individual medical decision. Low potassium can affect interpretation, which is why the guideline says potassium should be assessed alongside aldosterone and renin.

Sources: Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline

ELIXIR is the next test, not the final answer

The next research step is ELIXIR, a prospective study registered under NCT07800858. Its registry entry describes a planned 30-participant, open-label, single-group study of baxdrostat taken once daily for 24 weeks. The protocol includes molecular PET-CT imaging of adrenal tissue, alongside blood-pressure and hormone measurements before, during and after treatment. The registry lists no placebo or comparison group, making the study exploratory even though it is larger than the 14-person follow-up.

The registry was last updated on 2 September 2026 and at that time listed ELIXIR as not yet recruiting, with an estimated start date of 15 September. Because that public record predates the November report, the study's current recruitment status could not be independently confirmed. Researchers hope the imaging will show whether prolonged enzyme inhibition changes aldosterone-producing tissue and whether any biochemical or blood-pressure effects persist after treatment stops. Until larger studies report results, EASI remains a promising research direction, not an established cure. The registry estimates completion in May 2028, but projected dates are not confirmed milestones.

Sources: New treatment may cure common hormonal cause of high blood pressure · Baxdrostat and Molecular Imaging of Adrenal Cytoreduction in Primary Aldosteronism