Key result
Esaxerenone lowers morning home SBP ~2 mmHg more than trichlormethiazide in low NT-proBNP patients.
Why the study?
It was unknown whether baseline NT-proBNP levels affect the efficacy and safety of esaxerenone versus trichlormethiazide in patients with uncontrolled essential hypertension.
Does esaxerenone reduce morning home SBP/DBP compared to trichlormethiazide in Japanese patients with uncontrolled essential hypertension stratified by baseline NT-proBNP?
RCT (n=490)
Open-label
Randomized
Yes
Does esaxerenone reduce morning home SBP/DBP compared to trichlormethiazide in Japanese patients with uncontrolled essential hypertension stratified by baseline NT-proBNP?
Mean Difference: -2 (95% CI -3.5–-0.4)
Absolute Event Rate: -11.5% vs -9.6%
May favor esaxerenone for morning SBP control in low NT-proBNP hypertension; hypothesis-generating for NT-proBNP-stratified therapy.
It is currently unknown whether baseline N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, a marker of pressure-related cardiac stress, affect the efficacy and safety of esaxerenone vs trichlormethiazide. This exploratory subanalysis of the EXCITE-HT study aimed to compare the antihypertensive efficacy and safety of esaxerenone vs trichlormethiazide in Japanese patients with uncontrolled essential hypertension stratified by baseline NT-proBNP. EXCITE-HT was a randomized, open-label, parallel-group study. In this subanalysis, patients were divided into low and high NT-proBNP subgroups based on their baseline levels (<125 pg/mL and ≥125 pg/mL, respectively). The low NT-proBNP subgroup included 188 and 212 patients and the high NT-proBNP subgroup included 49 and 41 patients in the esaxerenone and trichlormethiazide groups, respectively. A significant decrease in morning home systolic/diastolic blood pressure (SBP/DBP; the primary endpoint) was observed from baseline to the end of treatment in both NT-proBNP subgroups. In the low NT-proBNP subgroup, esaxerenone was superior to trichlormethiazide in lowering SBP and non-inferior in lowering DBP. Non-inferiority could not be confirmed in the high NT-proBNP subgroup. The geometric mean urinary albumin-to-creatinine ratio significantly decreased from baseline to Week 12 in all subgroups (all P < 0.001 vs baseline). No cases of serum potassium level ≥6.0 mEq/L were reported. These findings suggest that esaxerenone is efficacious across a wide range of baseline NT-proBNP levels, while also supporting its favorable safety profile.
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Kario et al. (2025) conducted an RCT in Uncontrolled essential hypertension (n=490). Esaxerenone vs. Trichlormethiazide was evaluated on Change in morning home systolic blood pressure from baseline to end of treatment in the low NT-proBNP subgroup (MD -2.0, 95% CI -3.5, -0.4). In patients with uncontrolled essential hypertension and low baseline NT-proBNP, esaxerenone was superior to trichlormethiazide in lowering morning home systolic blood pressure (between-group difference -2.0 mmHg), whereas non-inferiority was not confirmed in the high NT-proBNP subgroup.
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