Intensive Blood Pressure Control and Cardiovascular Outcomes in Type 2 Diabetes According to a Biomarker Risk Score: ACCORD Cardiac Biomarker Ancillary Study

Presenter: Leonard Chiu.

In the Action to Control Cardiovascular Risk in Diabetes blood pressure (ACCORD-BP) trial, intensive blood pressure (BP) control (systolic target <120 mm Hg) did not reduce cardiovascular disease (CVD) risk compared with standard control (<140 mm Hg). This ancillary analysis asked whether a biomarker score could identify participants more likely to benefit. One point each was assigned for N-terminal pro-B-type natriuretic peptide (NT-proBNP) ≥125 ng/L, high-sensitivity cardiac troponin T (hs-cTnT) ≥6 ng/L, high-sensitivity C-reactive protein (hs-CRP) ≥3 mg/L and electrocardiographic left ventricular hypertrophy. Among 3,326 participants followed for a median of 9.1 years, 45.4%, 41.3% and 13.3% had low, intermediate and high scores. CVD risk was higher in the intermediate (adjusted hazard ratio [aHR] 1.40 [95% confidence interval (CI): 1.14-1.72]) and high score groups (aHR 1.69 [95% CI: 1.30-2.20]). Intensive BP control reduced CVD risk in the high score group (aHR 0.64 [95% CI: 0.44-0.95]) but not in the intermediate (aHR 0.97) or low score groups (aHR 1.20) (P-interaction = 0.046). The biomarker score was therefore associated with CVD risk and identified a subgroup that benefited from intensive BP control.

Effects of Orforglipron on Blood Pressure: Post-Hoc Analyses from ATTAIN-1 and ATTAIN-2 Trials

Presenter: Luke J Laffin.

Hypertension is a highly prevalent complication of, and key contributor to, cardiometabolic risk. Orforglipron, an oral small-molecule glucagon-like peptide-1 receptor agonist, produced meaningful weight reduction in the Phase 3 ATTAIN-1 (obesity) and ATTAIN-2 (obesity and type 2 diabetes) trials, and these post hoc analyses examined its effect on office blood pressure (BP) by baseline BP category. Over 72 weeks, orforglipron lowered systolic BP (SBP) versus placebo in both trials (ATTAIN-1: -6.1 vs -0.8 mmHg; ATTAIN-2: -4.9 vs -1.5 mmHg; p<0.001 for both). Diastolic BP (DBP) fell significantly in ATTAIN-1 (-2.5 vs -0.9 mmHg; p<0.001) but not in ATTAIN-2 (-1.3 vs -1.4 mmHg; p=0.87). SBP reductions were greater than placebo in stage 1 and stage 2 hypertension, reaching -15.9 vs -11.1 mmHg (ATTAIN-1) and -15.8 vs -8.2 mmHg (ATTAIN-2) in stage 2 (p<0.001 for all). Weight reduction explained about 58% and 80.8% of the SBP change in ATTAIN-1 and ATTAIN-2, respectively. Orforglipron thus improved SBP across baseline BP categories, with an effect that appeared at least partly independent of weight loss.

Comparative Renal Safety and Efficacy of Baxdrostat vs Lorundrostat in Hypertensive Patients: A Systematic Review and Network Meta-Analysis

Presenter: Khawaja Momal Hassan.

Selective aldosterone synthase inhibitors (ASIs) such as baxdrostat and lorundrostat offer a potent approach to blood pressure control in hypertension, but their comparative renal safety across dosages is inadequately defined. This frequentist network meta-analysis of ten randomised controlled trials (3475 patients) compared doses of both agents with placebo. A ≥30% decline in estimated glomerular filtration rate (eGFR) was more likely with baxdrostat 2mg (odds ratio [OR] 8.77 [4.26-18.05]), baxdrostat 1mg (OR 7.06 [3.15-15.85]) and lorundrostat 100mg (OR 3.08 [1.10-8.60]), and only baxdrostat 2mg significantly reduced absolute eGFR (mean difference [MD] 7.01 mL/min/1.73m²). Hyperkalemia increased with lorundrostat 100mg (OR 7.64) and baxdrostat 2mg (OR 4.18), and hyponatremia only with lorundrostat 100mg (OR 2.67). Lorundrostat 50mg (MD -9.42) and baxdrostat 2mg (MD -8.54) produced the greatest systolic reductions, with lorundrostat 50mg ranking highest for diastolic reduction (MD -6.00). Both agents lower blood pressure but carry dose-dependent renal risks; lorundrostat 50mg offered the best balance of efficacy and renal safety, supporting personalised, dose-conscious ASI selection.

Baxdrostat in Resistant and Uncontrolled Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Presenter: Adir Alper.

Aldosterone dysregulation is increasingly recognised as a key factor in resistant hypertension, and baxdrostat, a highly selective aldosterone synthase inhibitor, has been tested in several hypertensive populations. This meta-analysis pooled five randomised, double-blind, placebo-controlled trials (BrigHTN, HALO, BaxHTN, FigHTN and Bax24; N=1,730). Baxdrostat reduced seated systolic blood pressure (SBP) versus placebo (mean difference [MD] -6.90 mm Hg; P<0.0001; I2=74%), with a dose-response: -8.16 mm Hg at 2 mg (P<0.00001) and -6.06 mm Hg at 1 mg (P=0.01), while 0.5 mg was non-significant (P=0.14). It increased the odds of achieving SBP <130 mm Hg (odds ratio [OR] 2.70; P=0.01) and reduced diastolic blood pressure at 2 mg (MD -3.51 mm Hg) and 1 mg (MD -2.55 mm Hg). Hyperkalemia was more frequent (8.9% vs 1.2%; OR 5.98; P = 0.008), with potassium >6.0 mmol/L in 3.8% versus 0.2%, but serious adverse events were not significantly increased (OR 1.35; P = 0.37). Baxdrostat therefore lowered SBP in a dose-dependent manner, with hyperkalemia the principal but clinically non-serious concern; its definitive positioning awaits ongoing cardiovascular and renal outcomes trials.

Collaboration Oriented Approach to Controlling High Blood Pressure: A Pragmatic Randomized Controlled Trial

Presenter: LeAnn Michaels.

Home blood pressure (BP) monitoring is recommended, yet integrating patient-generated readings into primary care workflows to support self-management remains challenging. COACH (Collaboration Oriented Approach to Controlling High Blood Pressure) is a patient- and clinician-facing digital clinical decision support application linking home BP data, guidelines and patient goals to portal and electronic health record workflows. This pragmatic randomised trial across three academic health systems compared an enhanced version with affective alerts and visualisations (n=290) against a basic version (n=284) in 574 adults with uncontrolled BP who received a home monitor. Mean baseline BP was 150.4/87.4 mmHg. At six months, BP fell by -17.4/-5.8 mmHg across both groups (p<.0001), and 52.1% of patients were controlled. Contrary to the hypothesis, the basic arm achieved higher control rates (58.5% vs 45.9%, p<.001), with a similar percent decrease in BP (12.0% vs 11.1%). The authors conclude that the basic arm was more effective, and that behaviourally informed, integrated digital tools offer an effective strategy for optimising home BP management in primary care.

Real-World Effectiveness of Azelnidipine/Telmisartan Fixed-Dose Combination as Initial Therapy in Newly Diagnosed Hypertension: Data from ACT-HTN Study

Presenter: Ashutosh Kakkad.

Early blood pressure (BP) control is critical to reducing cardiovascular and renal risk in newly diagnosed hypertension, and although guidelines favour single-pill combinations as initial therapy, real-world evidence remains limited. ACT-HTN, a retrospective observational study across ~200 outpatient clinics in India, evaluated azelnidipine/telmisartan fixed-dose combination (FDC) as first-line therapy for at least 12 weeks. Among 848 evaluable patients, systolic BP (SBP) fell by 18.0±0.76 mmHg and diastolic BP (DBP) by 11.8±0.78 mmHg at week 12±2 (both p<0.0001). Target attainment (SBP <130 mmHg and DBP <80 mmHg) rose from 6.6% and 2.6% at week 12 to 35.4% and 8.9% at week 24. Among 783 patients with 24-week data, further reductions of 12.8±0.73 mmHg (SBP) and 8.5±0.6 mmHg (DBP) were observed. Heart rate decreased by 6.1±0.6 bpm and serum creatinine by 0.12±0.01 mg/dL at week 12, and adverse events were infrequent (3.4%). The FDC produced significant, sustained BP reduction with good tolerability; the authors suggest the concurrent heart rate and creatinine reductions indicate potential cardio-renal benefits.

American Heart Association (AHA) Scientific Sessions 2026, November 6–9, Chicago, Illinois