Why the study?
Because nocturnal blood pressure is superior to daytime blood pressure in predicting cardiovascular mortality, evaluating the effect of esaxerenone combination therapy on nighttime blood pressure in uncontrolled hypertension is clinically relevant.
Does esaxerenone monotherapy or combination therapy with a CCB or RASi reduce nocturnal blood pressure and NT-proBNP in Japanese patients with uncontrolled hypertension?
Does esaxerenone monotherapy or combination therapy with a CCB or RASi reduce nocturnal blood pressure and NT-proBNP in Japanese patients with uncontrolled hypertension?
Esaxerenone, particularly when combined with a renin-angiotensin system inhibitor, significantly reduces nocturnal blood pressure and NT-proBNP levels in Japanese patients with uncontrolled hypertension.
Supports nocturnal BP assessment with esaxerenone; leaves open randomized confirmation of outcome benefits.
BACKGROUND: Nocturnal blood pressure (BP) is superior to daytime BP in predicting cardiovascular mortality. It is of clinical relevance to evaluate the effect of esaxerenone combination therapy on nighttime BP in patients with uncontrolled hypertension. METHODS: A post hoc analysis of a multicenter, open-label, phase 3 study evaluated the nighttime BP-lowering effects of esaxerenone as monotherapy or in combination with a calcium channel blocker (CCB) or renin-angiotensin system inhibitor (RASi) in Japanese patients with uncontrolled hypertension. In addition, the effect on N-terminal pro B-type natriuretic peptide (NT-proBNP), a known biomarker of cardiovascular disease prognosis, was evaluated. RESULTS: In total, 270 patients were included in this analysis (172, 49, and 49 patients in the monotherapy, CCB, and RASi groups, respectively). The 24-hour ambulatory systolic BP reduction from baseline was - 10.0, - 6.0, and - 17.0 mm Hg in the monotherapy, CCB, and RASi groups, respectively. Nighttime systolic BP decreased significantly from baseline to week 28 in all groups (P < 0.001 each); the RASi group showed the greatest change (- 20.6 mm Hg). NT-proBNP decreased significantly in all three treatment groups. CONCLUSIONS: Esaxerenone when used in combination with a CCB or RASi, but especially when used in combination with a RASi, may be a useful treatment option for patients with uncontrolled hypertension to control nocturnal BP.
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Kario et al. (2025) studied this question.
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