Key result
Switching to esaxerenone from eplerenone cuts systolic blood pressure by ~10 mmHg in hypertensive HF.
Why the study?
The clinical effects of switching from eplerenone to the non-steroidal mineralocorticoid receptor antagonist esaxerenone in patients with chronic heart failure complicated by hypertension remain unclear.
Does switching from eplerenone to esaxerenone improve blood pressure and cardiorenal biomarkers in patients with chronic heart failure and hypertension?
Does switching from eplerenone to esaxerenone improve blood pressure and cardiorenal biomarkers in patients with chronic heart failure and hypertension?
Absolute Event Rate: 122% vs 131.5%
p-value: p=<0.001
Switching from the steroidal MRA eplerenone to the non-steroidal MRA esaxerenone in patients with chronic heart failure and hypertension safely improved blood pressure, BNP, and renal parameters despite compensatory RAAS activation.
Switching may aid BP control in chronic HF with hypertension; hypothesis-generating for cardiorenal effects and requires RCTs before practice change.
Background/Objectives: Esaxerenone is a non-steroidal mineralocorticoid receptor antagonist (MRA) with potent cardiorenal protective effects. However, the clinical effects of switching from eplerenone to esaxerenone in patients with chronic heart failure complicated by hypertension remain unclear. This study investigated the effects of switching from eplerenone to esaxerenone on blood pressure, heart failure biomarkers, renal function, and the renin–angiotensin–aldosterone system (RAAS). Methods: A total of 156 patients with chronic heart failure and hypertension who had been receiving eplerenone for more than one year were prospectively enrolled. Eplerenone was switched to esaxerenone, and the patients were followed for 6 months. Blood pressure, heart rate, brain natriuretic peptide (BNP), renal function, urinary albumin-to-creatinine ratio (UACR), plasma renin activity (PRA), plasma aldosterone concentration (PAC), and urinary osmolality (U-OSM) were evaluated. Results: Following the switch to esaxerenone, systolic and diastolic blood pressure significantly decreased (both p < 0.001), whereas heart rate remained unchanged. BNP levels significantly decreased at 3 and 6 months (p = 0.008 and p = 0.002, respectively). Serum creatinine decreased (p = 0.017), estimated glomerular filtration rate increased (p = 0.028), and UACR significantly decreased at both time points (both p < 0.001). PRA and PAC significantly increased after switching (both p < 0.05), whereas angiotensin II levels remained unchanged. U-OSM significantly decreased (p = 0.01 and p = 0.002 at 3 and 6 months, respectively). No major cardiovascular events or severe adverse events were observed. Conclusions: In patients with chronic heart failure and hypertension, switching from eplerenone to esaxerenone was associated with reductions in blood pressure, BNP, UACR, and urinary osmolality, together with improvements in renal function. These findings suggest favorable physiological changes following the switch from a steroidal to a non-steroidal mineralocorticoid receptor antagonist, although confirmation in randomized controlled studies with clinical outcome measures is warranted.
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Sezai et al. (2026) studied Chronic heart failure and hypertension (n=156). Esaxerenone vs. Eplerenone (baseline) was evaluated on Systolic blood pressure at 6 months (p=<0.001). Switching from eplerenone to esaxerenone in patients with chronic heart failure and hypertension significantly reduced systolic blood pressure from 131.5 mmHg to 122.0 mmHg (p < 0.001).
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