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Effects of esaxerenone on blood pressure, urinary albumin excretion, serum levels of NT-proBNP, and quality of life in patients with primary aldosteronism

Hypertension Research volume 47, pages 157–167 (2024)Cite this article

Abstract

Primary aldosteronism (PA) is typically managed with mineralocorticoid receptor antagonists (MRAs) barring adrenalectomy. The efficacy of esaxerenone, a nonsteroidal MRA, were explored in patients with PA. Various parameters such as the urinary albumin to creatinine ratio (UACR) and serum levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) were evaluated in 25 PA patients before and 3 and 6 months after esaxerenone treatment. Systolic and diastolic blood pressure (BP), and the estimated glomerular filtration rate decreased after treatment, while serum levels of potassium and active renin increased. Significant reductions were observed in UACR 3 and 6 months after treatment. A significant decrease in NT-proBNP was evident at 6 months but not 3 months after treatment. Correlation analysis indicated that the reductions in BP and UACR at 3 months were independent of estimated daily salt intake. Furthermore, the effect of esaxerenone treatment on lowering UACR and NT-proBNP levels was independent of BP reduction. Responders whose systolic BP decreased 6 months after esaxerenone treatment by more than 10 mmHg compared to pretreatment had higher pretreatment NT-proBNP and similar UACR before and after treatment when compared with nonresponders. Esaxerenone improved mental, physical, and social quality of life (QOL) 6 months after treatment compared to healthy controls and increased over time. No patients discontinued treatment due to severe hyperkalemia or renal dysfunction. In conclusion, esaxerenone is a safe and effective MRA for PA treatment, offering significant benefits in terms of hypertension, albuminuria, NT-proBNP levels, and QOL improvement.

Esaxerenone effectively lowers BP, UACR, and serum levels of NT-proBNP independent of dietary salt intake in mild PA patients. ARC active renin concentration, DBP diastolic blood pressure, MR mineralocorticoid receptor, MRA mineralocorticoid receptor antagonist, NT-proBNP N-terminal pro-brain natriuretic peptide, PA primary aldosteronism, QOL quality of life, SBP systolic blood pressure, SF-36 Medical Outcomes Study 36-Item Short-Form Health Survey, UACR urinary albumin to creatinine ratio.

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Acknowledgements

We thank the physicians and medical staff of the Department of Endocrinology and Diabetology, Oita University Hospital, who treated the patients who participated in this study.

Funding

This study was funded by Daiwa Securities Health Foundation #48-①-24and by Grand-in-Aid for the Intractable Adrenal Disorders Research by the Ministry of Health, Labour and Welfare (HS).

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Authors and Affiliations

  1. Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu, Japan

    Yuichi Yoshida, Mizuki Kinoshita, Kentaro Sada, Shotaro Miyamoto, Yoshinori Ozeki, Miyuki Iwamoto, Yumi Mori, Satoshi Nagai, Naoki Matsuda, Takaaki Noguchi, Mitsuhiro Okamoto, Koro Gotoh, Takayuki Masaki & Hirotaka Shibata

  2. Faculty of Medicine, Oita University, Yufu, Japan

    Mio Fujiwara

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Correspondence to Hirotaka Shibata.

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HS has honorarium from Daiichi-Sankyo Company, Bayer, Mochida Pharmaceuticals, Astrazeneca, Novartis Pharma, and Astellas. HS also received scholarship from Chugai and Bayer.

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Yoshida, Y., Fujiwara, M., Kinoshita, M. et al. Effects of esaxerenone on blood pressure, urinary albumin excretion, serum levels of NT-proBNP, and quality of life in patients with primary aldosteronism. Hypertens Res 47, 157–167 (2024). https://doi.org/10.1038/s41440-023-01412-w

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