Esaxerenone shows promise for hypertensive patients with primary aldosteronism

Esaxerenone, a novel nonsteroidal mineralocorticoid receptor (MR) blocker, has good safety and efficacy profiles in patients with hypertension and primary aldosteronism (PA), a recent Japan study has found.

The researchers conducted a multicentre, open-label study including 44 patients (mean age 49.6±9.68 years, 56.8 percent women) with hypertension and PA. Esaxerenone was given for 12 weeks at a starting dose of 2.5 mg/day, escalating to 5 mg/day during weeks 2 or 4, based on patient response. The primary efficacy outcome was the change in sitting systolic (SBP) and diastolic (DBP) blood pressure.

The mean sitting SBP was 154.0±9.8 mm Hg at baseline, which dropped to 136.4±13.6 mm Hg at the end of treatment. DBP likewise showed a downward trend, decreasing from 100.0±5.9 to 90.5±8.6 mm Hg (p<0.0001 for both). Such reductions became apparent as early as week 2 and continued until week 8, after which changes remained stable until the end of the trial.

Nearly half (47.7 percent) of the participants achieved a sitting BP of <140/90 mm Hg at the end of the treatment.

In terms of safety, the researchers documented treatment-emergent adverse events in 27 of the patients, yielding an overall rate of 61.4 percent. Side effects deemed related to the test treatment were reported in 25.0 percent of patients. One serious adverse event was documented, though it was not considered associated to esaxerenone.

Two patients discontinued treatment due to adverse events; no deaths occurred.

“This study is the first to investigate the antihypertensive effects of a novel MR blocker, esaxerenone, in hypertensive patients diagnosed with PA. Esaxerenone had a clinically significant antihypertensive effect in Japanese hypertensive patients with PA and was well tolerated, with consistent efficacy across a range of patient subgroups,” the researchers said.