Key result
Esaxerenone shows short-term safety in hypertensive HFrEF patients with 0% hyperkalemia and hypotension.
Why the study?
Esaxerenone is a new antihypertensive mineralocorticoid receptor blocker, but data regarding its use in hypertension with heart failure are limited.
Does esaxerenone safely reduce BNP levels without causing hyperkalemia or hypotension in hypertensive patients with HFrEF?
Observational (n=50)
No
Does esaxerenone safely reduce BNP levels without causing hyperkalemia or hypotension in hypertensive patients with HFrEF?
Esaxerenone appears safe and effective in reducing BNP levels without causing significant hyperkalemia or hypotension in Japanese hypertensive patients with HFrEF.
Short-term tolerability in this cohort supports further study; hypothesis-generating and requires randomized confirmation before clinical consideration.
Esaxerenone, a mineralocorticoid receptor blocker (MRB), is a new antihypertensive agent. However, esaxerenone-related data with respect to hypertension with heart failure are limited. We investigated the safety and efficacy of esaxerenone in hypertensive patients with heart failure with reduced ejection fraction (HFrEF). Hypertensive patients with HFrEF treated with esaxerenone were retrospectively analyzed at two timepoints (short-term: 35±15 days; mid-term: 167±45 days). Adverse events including hyperkalemia (K+ >5.5 mEq/L), worsening renal function (WRF; estimated glomerular filtration rate (eGFR) reduction by ≥20%), and hypotension (systolic blood pressure <90 mmHg) were evaluated. eGFR and K+, serum creatinine, and brain natriuretic peptide (BNP) levels at baseline, short-term, and mid-term assessments were compared. Patients administered esaxerenone as their first MRB (first-MRB cohort) and those who converted from another MRB (conversion cohort) were separately analyzed. There were 50 (56±10 years old, 26% female) patients. At the short-term assessment, hyperkalemia or hypotension was not observed at a dose of 2.0±0.9 mg/day. Seven patients (14%) showed WRF. K+ was slightly elevated (4.12±0.41 to 4.25±0.39 mmol/L, p = 0.07) and eGFR was significantly reduced (66.9±19.6 mL/min/1.73 m2 to 62.4±19.7 mL/min/1.73 m2, p = 0.006). In the conversion cohort, significant changes in K+ and eGFR from baseline were not observed at the short-term assessment. BNP levels were consistently improved regardless of the cohorts (first-MRB cohort, 310 [110-370] pg/mL to 137 [47-152] pg/mL, p = 0.001; conversion cohort, 181 [30-203] pg/mL to 108 [26-146] pg/mL, p = 0.028). At the mid-term assessment, there were no significant changes in K+ and eGFR compared with the short-term assessment. In conclusion, esaxerenone was safe for hypertensive patients with HFrEF. Hyperkalemia and hypotension were rarely noted, while eGFR was marginally reduced. Moreover, esaxerenone might be beneficial for HFrEF in terms of BNP level reduction.
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Iwahana et al. (2021) conducted an observational in Hypertension with heart failure with reduced ejection fraction (HFrEF) (n=50). Esaxerenone vs. None (baseline comparison) was evaluated on Incidence of adverse events (hyperkalemia, worsening renal function, hypotension, cardiovascular events). Esaxerenone was safe for hypertensive patients with HFrEF, demonstrating 0% incidence of hyperkalemia and hypotension, and a 14% incidence of worsening renal function at short-term follow-up.
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