Potassium2026-06

Effect of Body Mass Index on the Efficacy and Safety of Esaxerenone Versus Trichlormethiazide for the Treatment of Japanese Patients with Uncontrolled Essential Hypertension: A Subanalysis of the Excite-HT Study.

Katsuya Tomohiro, Kario Kazuomi, Ohishi Mitsuru, Shimosawa Tatsuo et al. — Journal of clinical hypertension (Greenwich, Conn.)

Summary

This study compared two blood pressure medications in Japanese adults with high blood pressure, considering their body mass index (BMI). It found that both drugs effectively lowered blood pressure, but they had different effects on blood potassium levels. One drug tended to slightly increase potassium, while the other tended to decrease it, regardless of BMI.

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Key points

A study compared two blood pressure medications, esaxerenone and trichlormethiazide, in Japanese adults.
Both drugs were effective at lowering blood pressure, regardless of a patient's body mass index (BMI).
Esaxerenone tended to slightly increase blood potassium levels, while trichlormethiazide tended to decrease them.
Monitoring potassium levels is important when taking either of these medications for high blood pressure.

What the study looked at

What question the study asked: Researchers wanted to understand if two different blood pressure medications, esaxerenone and trichlormethiazide, worked similarly and had similar side effects in Japanese patients with uncontrolled high blood pressure, especially considering their body mass index (BMI). They were particularly interested in how these drugs affected blood pressure and potassium levels. How it was studied: This was a sub-analysis of a larger study, involving 585 Japanese adults with high blood pressure. Participants were randomly assigned to receive either esaxerenone or trichlormethiazide for 12 weeks. They were also categorized into groups based on whether their BMI was below or above 25 kg/m². Blood pressure was measured at home and in the clinic, and blood tests, including potassium levels, were regularly checked. What it found: The study found that both medications effectively lowered blood pressure across all BMI groups. Esaxerenone appeared to be slightly more effective at reducing morning systolic blood pressure. Regarding potassium, trichlormethiazide was more likely to cause low potassium levels, while esaxerenone was more likely to cause slightly elevated potassium levels, though no levels reached dangerously high points. These effects on potassium were observed regardless of BMI.

Dietary takeaway

This study highlights that certain blood pressure medications can affect your body's potassium levels, either increasing or decreasing them. While this research focuses on drug effects, maintaining a balanced diet rich in potassium-containing foods like fruits and vegetables is generally beneficial for blood pressure management. However, if you are on medication that impacts potassium, your doctor might advise specific dietary adjustments or monitoring, as one study alone isn't enough to make definitive dietary recommendations.

Abstract

This prespecified, exploratory, body mass index (BMI)-stratified analysis of the randomized, open-label EXCITE-HT study examined whether esaxerenone elicits a blood pressure (BP)-lowering effect similar to trichlormethiazide in Japanese patients with uncontrolled essential hypertension. Patients received either esaxerenone or trichlormethiazide for 12 weeks and were grouped by baseline BMI: <25 kg/m (low) or ≥25 kg/m (high). The primary endpoint was change in morning home systolic/diastolic BP (SBP/DBP). Among 585 patients, 157 and 135 with low BMI received esaxerenone and trichlormethiazide, respectively; in the high BMI subgroup, 138 and 155 patients received esaxerenone or trichlormethiazide. The least squares mean between-group differences (esaxerenone-trichlormethiazide) were -2.1 mmHg (95% confidence interval [-4.1, -0.1])/-0.1 mmHg (-1.2, 1.0) and -2.0 mmHg (-4.0, -0.1)/-1.0 mmHg (-2.2, 0.2) for SBP/DBP in the low and high BMI subgroups, respectively. Bedtime home and office BP showed comparable tendencies. The incidence of serum potassium <3.5 mEq/L was more common with trichlormethiazide, whereas serum potassium ≥5.5 mEq/L occurred more frequently with esaxerenone; serum potassium never reached ≥6.0 mEq/L in any subgroup. Both drugs showed transient, modest decreases in creatinine-based estimated glomerular filtration rate that stabilized by Week 12. These exploratory findings, consistent with the primary study results, suggest that esaxerenone provides effective and well-tolerated BP control regardless of baseline BMI and may lower early-morning SBP to a greater extent than trichlormethiazide.

View on PubMed →DOI: 10.1111/jch.70314