Key result
Esaxerenone reduces nighttime systolic BP by up to ~6 mm Hg versus eplerenone.
Why the study?
Nocturnal hypertension is a known risk marker for target organ damage and cardiovascular events, prompting an assessment of the differential BP-lowering effects of esaxerenone versus eplerenone on nocturnal BP in hypertensive patients with different dipping patterns.
Does esaxerenone reduce nighttime systolic blood pressure compared to eplerenone in patients with essential hypertension?
RCT (n=1,001)
Double-blind
randomized
Yes
Does esaxerenone reduce nighttime systolic blood pressure compared to eplerenone in patients with essential hypertension?
Effect estimate: Difference -2.6 mm Hg (2.5 mg) and -6.4 mm Hg (5 mg) (95% CI -5.0 to -0.2 and -8.8 to -4.0)
Esaxerenone at 2.5 mg or 5 mg daily provides significantly greater reductions in nighttime systolic blood pressure compared to eplerenone 50 mg daily in patients with essential hypertension, particularly in non-dippers and older patients.
Esaxerenone may improve nocturnal BP control over eplerenone in essential hypertension; extends MRA head-to-head data to nighttime systolic BP.
BACKGROUND: Nocturnal hypertension is an important phenotype of abnormal diurnal blood pressure (BP) variability and a known risk marker for target organ damage and cardiovascular events. This study aimed to assess the differential BP-lowering effects of esaxerenone vs. eplerenone on nocturnal BP in hypertensive patients with different nocturnal dipping patterns. METHODS: This was a post hoc analysis of the "Esaxerenone (CS-3150) Compared to Eplerenone in Patients with Essential Hypertension" study (NCT02890173), which was a phase 3, multicenter, randomized, controlled, double-blind, parallel-group clinical study conducted in Japan. Ambulatory BP monitoring data were collected. RESULTS: Patients (n = 1,001) were randomized to esaxerenone 2.5 mg/day (n = 331) or 5 mg/day (n = 338), or eplerenone 50 mg/day (n = 332). Reductions in nighttime systolic BP (95% confidence interval) were significantly greater with 2.5 and 5 mg/day esaxerenone vs. eplerenone (-2.6 [-5.0, -0.2] and -6.4 mm Hg [-8.8, -4.0], respectively). Esaxerenone significantly reduced nighttime BP from baseline compared with eplerenone in non-dippers with previously uncontrolled BP. In addition, esaxerenone did not markedly alter nighttime BP in extreme dipper patients. In the esaxerenone 5 mg/day group, esaxerenone-induced decreases in nighttime BP were greater than eplerenone-induced decreases in older patients. CONCLUSIONS: Esaxerenone may be an effective treatment option for nocturnal hypertension, especially in older patients and those with a non-dipper pattern of nocturnal BP.
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Kario et al. (2020) conducted an RCT in Essential hypertension (n=1,001). Esaxerenone vs. Eplerenone 50 mg/day was evaluated on Reductions in nighttime systolic BP (Difference -2.6 mm Hg (2.5 mg) and -6.4 mm Hg (5 mg), 95% CI -5.0 to -0.2 and -8.8 to -4.0). Esaxerenone 2.5 and 5 mg/day significantly reduced nighttime systolic BP compared to eplerenone (differences of -2.6 mm Hg [95% CI -5.0 to -0.2] and -6.4 mm Hg [95% CI -8.8 to -4.0], respectively).
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