Key result
Novel MRAs, patiromer-enabled spironolactone, and chlorthalidone lower systolic BP by ~10 mmHg in advanced CKD.
Why the study?
The study was conducted to present recent developments in the pharmacotherapy of hypertension in patients with advanced chronic kidney disease.
Do patiromer-enabled spironolactone, novel non-steroidal MRAs, and chlorthalidone safely and effectively lower blood pressure in patients with advanced chronic kidney disease and uncontrolled or resistant hypertension?
Do patiromer-enabled spironolactone, novel non-steroidal MRAs, and chlorthalidone safely and effectively lower blood pressure in patients with advanced chronic kidney disease and uncontrolled or resistant hypertension?
This review highlights three effective pharmacotherapeutic strategies—patiromer-enabled spironolactone, novel nonsteroidal MRAs (such as KBP-5074 and esaxerenone), and chlorthalidone—that provide clinically meaningful blood pressure reductions in high-risk patients with advanced CKD and uncontrolled or resistant hypertension.
Answers are grounded in this paper and cite their sources.
May offer BP-lowering options in advanced CKD hypertension; leaves open need for dedicated RCTs on safety and outcomes.
PURPOSE OF REVIEW: The aim of this study was to present recent developments in pharmacotherapy of hypertension in patients with advanced chronic kidney disease (CKD). RECENT FINDINGS: In the AMBER trial, compared with placebo, the potassium-binder patiromer mitigated the risk of hyperkalaemia and enabled more patients with uncontrolled resistant hypertension and stage 3b/4 CKD to tolerate and continue spironolactone treatment; add-on therapy with spironolactone provoked a clinically meaningful reduction of 11-12 mmHg in unattended automated office SBP over 12 weeks of follow-up. In the BLOCK-CKD trial, the investigational nonsteroidal mineralocorticoid-receptor-antagonist (MRA) KBP-5074 lowered office SBP by 7-10 mmHg relative to placebo at 84 days with a minimal risk of hyperkalaemia in patients with advanced CKD and uncontrolled hypertension. The CLICK trial showed that the thiazide-like diuretic chlorthalidone provoked a placebo-subtracted reduction of 10.5 mmHg in 24-h ambulatory SBP at 12 weeks in patients with stage 4 CKD and poorly controlled hypertension. SUMMARY: Enablement of more persistent spironolactone use with newer potassium-binding agents, the clinical development of novel nonsteroidal MRAs with a more favourable benefit-risk profile and the recently proven blood pressure lowering action of chlorthalidone are three therapeutic opportunities for more effective management of hypertension in high-risk patients with advanced CKD.
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Georgianos et al. (2022) conducted a review in Hypertension in advanced chronic kidney disease. Patiromer-enabled spironolactone, nonsteroidal mineralocorticoid receptor antagonists (finerenone, esaxerenone, KBP-5074), and chlorthalidone vs. Placebo was evaluated on Systolic blood pressure reduction and persistence of therapy across reviewed trials. Patiromer-enabled spironolactone, novel nonsteroidal MRAs (KBP-5074), and chlorthalidone each lower systolic BP by 7 to 12 mmHg in patients with advanced CKD and uncontrolled hypertension.
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