AstraZeneca helped revolutionize high cholesterol treatment more than 20 years ago with the approval of its blockbuster, paradigm-shifting drug Crestor.
Now, the company is aiming to build on that legacy with Baxfendy, a first-in-class hypertension treatment that recently won FDA approval. The drug not only carries blockbuster potential, but is a linchpin in AstraZeneca’s “next-generation pipeline” for cardiovascular, renal and metabolic (CVRM) disease.
“Baxfendy marks an important moment as the first in a whole wave of additional medications we're bringing to the market in CVRM,” said Liz Bodin, vice president of AstraZeneca’s cardiovascular, renal and metabolic therapy area in the U.S.
While oncology remains its largest therapeutic bucket — accounting for 44% of its revenue last year — riding the wave of its CVRM portfolio will be critical to AstraZeneca’s larger growth strategy.
The company added Baxfendy to its roster when it acquired CinCor Pharma in a $1.3 billion deal in 2023. The following year, it entered an exclusive license agreement with CSPC Pharmaceutical Group to develop an early stage, novel small molecule lipoprotein disruptor and bolster its cardio prowess.
“The burden of CVRM diseases is predicted to continue to grow,” Bodin said.
AstraZeneca noted in its 2025 annual report that 50% of deaths worldwide are predicted to be caused by CVRM-related diseases by 2040 — and the company is positioning itself to be at the forefront of the space.
“We really see ourselves as a full-service CVRM company,” Bodin said.
Filling an innovation gap
Baxfendy’s approval relieves a more than two-decade drought in hypertension treatment innovation by “working in a fundamentally different way” than existing options, according to Bodin.
“It's a highly selective aldosterone synthase inhibitor,” she said. “It targets a key underlying driver of hypertension, and that is the hormone aldosterone. So it's working at the source.”
Baxfendy was approved as a combo therapy with other antihypertensive medications, a distinction that Bodin said addresses a critical element of the area’s unmet need. In the U.S. alone, 23 million patients have uncontrolled hypertension despite being on two or more medicines to treat it.
“They're still not able to adequately control their blood pressure. And that's where we see Baxfendy coming into play,” Bodin said.
Baxfendy hit all its endpoints in a phase 3 trial, reducing systolic blood pressure to a level linked to a lower risk of heart attack, stroke, heart failure and kidney disease, according to the company.
“These data show that aldosterone plays a greater role in hard-to-control hypertension than previously recognized,” Dr. Bryan Williams, Chair of Medicine at University College London and a primary investigator for the trial, said in a release.
Now, the goal is to expand Baxfendy’s reach. To that end, AstraZeneca is in late-stage clinical trials of Baxfendy in chronic kidney disease, heart failure and primary aldosteronism, which affects the adrenal glands and causes hypertension.
If it gets on a roll, Baxfendy could become one of AstraZeneca’s top sellers.
“Because of the differentiated mechanism that we have with Baxfendy and the potential to treat such a large population of patients across those four indications … we estimate a peak-year revenue opportunity of $5 billion across that franchise,” Bodin said.
But first, the company needs to get Baxfendy off the ground in hypertension.
“The lack of innovation is leading to patients continuing to be challenged to achieve their goals in this disease,” she said. “Casting light on that unmet need is a fundamental part of what we need to do to be successful with this launch.”
In CVRM, it’s all connected
AstraZeneca’s broader CVRM strategy could tap into the overlap of conditions like hypertension, cardiorenal disease, chronic kidney disease and obesity.
For example, 40%–50% of patients with heart failure also have chronic kidney disease.
“In many cases, patients are suffering with multiple conditions that are ultimately causing adverse impact on their heart and or kidneys,” Bodin said.
She pointed to a robust CVRM program and pipeline to address this interplay, in addition to an existing portfolio that includes drugs like Crestor, Farxiga and Brilinta. The company is conducting a cardiomyopathy study for Wainua, which is currently approved to treat polyneuropathy in adults with hereditary transthyretin-mediated amyloidosis. It’s also developing cardiorenal therapies and an oral PCSK9 inhibitor for dyslipidemia, as well as growing its weight management portfolio.
“That puts us in a place to think about the patient holistically and think about the interconnected nature of these diseases. They're often managed by the same clinicians as well,” Bodin said.
