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, esaxerenone and trichlormethiazide, in Japanese patients with high blood pressure that wasn't well-controlled. Researchers looked at how well these drugs worked and their safety, specifically checking if a patient's BMI (body mass index) made a difference. The findings suggest that esaxerenone effectively lowers blood pressure and is well-tolerated, regardless of whether a patient has a lower or higher BMI, and might even be better at reducing early-morning blood pressure than trichlormethiazide.

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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