Chronic esaxerenone treatment improves vascular function and lowers peripheral arterial stiffness in patients with idiopathic hyperaldosteronism

OBJECTIVE: Primary aldosteronism is one of the most common types of secondary endocrine hypertension. Treatment with mineralocorticoid receptor antagonists is recommended for bilateral idiopathic hyperaldosteronism (IHA). The purpose of this study was to evaluate the effects of esaxerenone, a nonsteroidal mineralocorticoid receptor antagonist with high mineralocorticoid receptor-binding specificity, on vascular function and peripheral arterial stiffness in patients with IHA. METHODS: This study was a single-center, observational prospective cohort study. Forty-four patients with IHA (18 men and 26 women; 52 ± 11 years) were enrolled from Hiroshima University Hospital. Vascular function, including flow-mediated vasodilation (FMD) and nitroglycerine-induced vasodilation (NID) and peripheral arterial stiffness, including brachial-ankle pulse wave velocity (baPWV) and brachial artery intima-media thickness (bIMT) were measured before and after 12 weeks of treatment with esaxerenone. RESULTS: Esaxerenone treatment increased FMD (3.1 ± 2.0% to 5.7 ± 2.2%, P < 0.01) and NID (10.7 ± 3.8% to 15.7 ± 6.2%, P < 0.01) and decreased baPWV (1605 ± 263 to 1428 ± 241 cm/s, P < 0.01), while esaxerenone treatment did not significantly alter bIMT. The changes in FMD and NID posttreatment with esaxerenone were significantly correlated with the changes in plasma aldosterone concentration (PAC) and plasma renin activity (PRA). The change in baPWV was significantly correlated with the changes in PRA, aldosterone-to-renin ratio, and systolic blood pressure. CONCLUSION: Esaxerenone improved vascular function and peripheral arterial stiffness in patients with IHA. These findings suggest aldosterone inhibition is a potential mechanism governing improvement in cardiovascular health.