Why the study?
Effective management of blood pressure and albuminuria is crucial for suppressing CKD progression and cardiovascular risks in hypertension, prompting an evaluation of esaxerenone's antihypertensive effects, organ-protective effects, and safety in hypertensive patients with CKD.
Does esaxerenone improve blood pressure and albuminuria in hypertensive patients with chronic kidney disease?
Does esaxerenone improve blood pressure and albuminuria in hypertensive patients with chronic kidney disease?
Esaxerenone provides significant and sustained blood pressure reduction and albuminuria improvement in hypertensive patients with CKD, regardless of T2DM status.
Supports esaxerenone for BP and albuminuria reduction in hypertensive CKD regardless of T2DM; leaves open confirmation in randomized trials.
Effective management of blood pressure (BP) and albuminuria are crucial for suppressing chronic kidney disease (CKD) progression and cardiovascular risks in hypertension. This pooled analysis evaluated the antihypertensive effects, organ-protective effects, and safety of esaxerenone in hypertensive patients with CKD by integrating five clinical studies of esaxerenone. Patients were divided based on type 2 diabetes mellitus (T2DM) status (with or without T2DM) and creatinine-based estimated glomerular filtration rate (eGFR creat ) (30 to <60 and ≥60 mL/min/1.73 m 2 ). Significant changes in morning home BP from baseline at Week 12 were observed in the overall population (mean change −12.8/ − 5.4 mmHg), T2DM subgroups ( − 12.2/ − 4.5 and −14.5/ − 7.8 mmHg), and eGFR creat subgroups ( − 12.5/ − 4.7 and −14.0/ − 6.9 mmHg) (all P < 0.001). Bedtime home and office BP showed similar tendencies. Urine albumin-to-creatinine ratio significantly improved from baseline at Week 12 in the overall population (mean change: −55.2%), T2DM subgroups ( − 56.5% and −52.0%), and eGFR creat subgroups ( − 54.6% and −55.4%) (all P < 0.001). N-terminal pro-B-type natriuretic peptide levels significantly decreased in the overall population (percent change: −14.1%) and subgroup without T2DM ( − 25.3%). The incidence of serum potassium ≥5.5 mEq/L was lower in the subgroup with T2DM vs without T2DM (3.1% and 11.3%), potentially related to the use of sodium–glucose cotransporter 2 inhibitors. These findings highlight the sustained BP-lowering effect of esaxerenone throughout the day in hypertensive patients with CKD, irrespective of T2DM status, and its significant reduction in albuminuria. The data support the safety and efficacy of esaxerenone in this patient population, underscoring its potential as a valuable therapeutic option.
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Uchida et al. (2025) studied this question.
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