Hemodynamic effects of finerenone on blood pressure and heart rate in hospitalized patients with type 2 diabetes: a real-world study

Background While the long-term cardiorenal benefits of finerenone have been established in landmark clinical trials, its immediate impact on hemodynamic parameters in routine clinical practice remains to be fully characterized. This study aimed to evaluate the real-world acute effects of finerenone on blood pressure (BP) and heart rate (HR) in hospitalized patients with type 2 diabetes (T2D). Methods We conducted a retrospective observational study of patients with T2D who were initiated on finerenone as part of standard clinical care. Patients were grouped into five cohorts based on the day of treatment initiation (Day 1 to Day 5). We monitored morning (a.m.) and afternoon (p.m.) systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) daily for 7 days. Baseline characteristics, including urinary albumin-to-creatinine ratio (UACR), serum potassium, and renin-angiotensin-aldosterone system (RAAS) markers, were assessed to reflect the real-world population’s heterogeneity. Results In this real-world cohort, finerenone was mainly prescribed to patients with notably high UACR (average grade III; p < 0.0001 compared to non-users), indicating its targeted use for high-risk kidney patients. Despite a complex background of intensive therapies—including ARBs (90.6%), CCBs (84.6%), and SGLT-2 inhibitors (91.4%)—adding finerenone was linked to significant decreases in both SBP and DBP. Daily detailed analysis showed that the largest BP reductions often occurred within the first 24–48 hours of treatment (p < 0.05 to p < 0.0001), across various treatment groups. Additionally, heart rate (HR) remained stable during the initial days of therapy. The distribution of background medications stayed consistent during finerenone treatment, suggesting that the hemodynamic improvements were not due to changes in other antihypertensive medications. Conclusion This real-world evidence indicates that finerenone was associated with antihypertensive effects in hospitalized T2D patients with albuminuria. Its ability to substantially reduce BP and stabilize HR shortly after hospitalization, despite concurrent standard therapies, underscores its practical utility in managing hypertension.