August 14, 2026European Journal of Heart Failure0 citations
View Full PaperFinerenone and apparent treatment-resistant hypertension in heart failure with mildly reduced or preserved ejection fraction
Key Result
Finerenone consistently improved clinical outcomes compared to placebo across all baseline hypertension categories (Pinteraction=0.32), including in the 12.9% of patients with apparent treatment-resistant hypertension.
Key Points
- To determine whether finerenone improves blood pressure, health status, and clinical outcomes in patients with HFmrEF or HFpEF across different categories of blood pressure control and apparent treatment-resistant hypertension.
- Conducted a pre-specified analysis of the randomized FINEARTS-HF trial in 6,001 participants followed over 36 months.
- Classified participants at baseline into controlled blood pressure (n=3,471), non-resistant hypertension (n=1,754), or apparent treatment-resistant hypertension (aTRH; n=776), defined as blood pressure ≥140/90 mm Hg (≥130/80 mm Hg with diabetes) despite use of ≥3 blood pressure medications including a diuretic.
- Assessed changes in systolic blood pressure, primary composite cardiovascular outcomes, health status, and safety profiles by baseline hypertension category.
- Finerenone reduced systolic blood pressure consistently across all baseline blood pressure categories over 36 months (Pinteraction = 0.59).
- Rates of cardiovascular death and total heart failure events per 100 person-years were 17.0 in controlled BP, 16.0 in non-resistant hypertension, and 13.8 in aTRH (Pcomparison = 0.12).
- Relative treatment benefits of finerenone versus placebo on the primary cardiovascular outcome (Pinteraction = 0.32) and heart failure-related health status (Pinteraction = 0.22) were consistent across all hypertension categories without modification of the safety profile.
Study Design
Type
RCT (n=6,001)
Structured PICO
Does finerenone improve clinical outcomes and blood pressure in individuals with HFmrEF/HFpEF across different baseline hypertension categories, including apparent treatment-resistant hypertension?
P
Population
6,001 participants with heart failure with mildly reduced or preserved ejection fraction, followed for 36 months.
I
Intervention
Finerenone
C
Comparator
Placebo
O
Outcome
Composite of cardiovascular death and total HF eventscomposite
Finerenone consistently improved clinical outcomes, health status, and blood pressure in patients with HFmrEF/HFpEF, regardless of baseline hypertension status, including those with apparent treatment-resistant hypertension.
Main Result
p-value: p=0.32 for interaction
Abstract
AIMS: Apparent treatment-resistant hypertension (aTRH) is common and associated with adverse outcomes in individuals with heart failure (HF) with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). Whether finerenone improves blood pressure (BP) and clinical outcomes in individuals with HFmrEF/HFpEF and aTRH is uncertain. METHODS: In this pre-specified analysis of the FINEARTS-HF trial, participants were categorized according to baseline BP, with aTRH defined as BP ≥140/90 mm Hg (≥130/80 mm Hg if diabetes) despite treatment with ≥3 BP-lowering medications, including a diuretic. Non-resistant hypertension was defined as BP above threshold but not meeting aTRH criteria. Controlled BP was defined as BP under the threshold. Incidence of clinical outcomes and safety events was assessed by baseline hypertension category. RESULTS: Among 6001 participants, 3471 (57.8%) had controlled blood pressure, 1754 (29.2%) had non-resistant hypertension, and 776 (12.9%) had aTRH at baseline. Between baseline and 36 months, finerenone similarly reduced systolic BP across baseline BP categories (Pinteraction = 0.59). Rates of cardiovascular death and total HF events (per 100 person-years) were 17.0 in those with controlled BP, 16.0 in those with non-resistant hypertension, and 13.8 in those with aTRH (Pcomparison = 0.12). Relative treatment benefits of finerenone vs placebo on the primary outcome (Pinteraction = 0.32) and HF-related health status (Pinteraction = 0.22) were consistent across hypertension categories. The safety profile of finerenone vs placebo did not appear to be modified by baseline hypertension category. CONCLUSION: aTRH was identified in 1-in-8 individuals with HFmrEF/HFpEF in FINEARTS-HF. Finerenone consistently improved clinical outcomes, health status, and blood pressure, including among those with aTRH.