Abstract 9146: Efficacy and Safety of Esaxerenone in Hypertensive Patients with Heart Failure with Reduced Ejection Fraction

Abstract

Introduction: Esaxerenone, a mineralocorticoid receptor blocker (MRB), is a new antihypertensive agent. However, esaxerenone-related data with respect to hypertension with heart failure are limited. Hypothesis: Esaxerenone is safe and effective for hypertensive patients with heart failure with reduced ejection fraction (HFrEF). Methods: Hypertensive patients with HFrEF treated with esaxerenone were retrospectively analyzed at two timepoints (short-term: 35±15 days; mid-term: 167±45 days) for hyperkalemia (K + >5.5 mEq/L), worsening renal function (WRF; estimated glomerular filtration rate (eGFR) reduction by >20%), and hypotension (systolic blood pressure <90 mmHg) along with brain natriuretic peptide (BNP) level. Patients administered esaxerenone as their first MRB (first-MRB cohort, n=20) and those who converted from another MRB (conversion cohort, n=30) were separately analyzed as sub analysis. Results: Fifty patients (56±10 years old, 37 males) were enrolled in this study. At the short-term assessment, hyperkalemia or hypotension was not observed at a dose of 2.0±0.9 mg/day. Seven patients (14%) showed WRF. K + and serum creatinine (Cre) were elevated (4.12±0.41 to 4.25±0.39 mmol/L, p =0.07, and 0.95±0.34 to 1.01±0.34 mg/dL, p =0.01, respectively), and eGFR was significantly reduced (66.9±19.6 to 62.4±19.7 mL/min/1.73 m 2 , p =0.006). At the mid-term assessment, there were no significant changes regarding K + , Cre and eGFR compared to those at the short-term. BNP levels were consistently lowered at the short-term and mid-term assessment. Sub analysis at the short-term assessment showed the changes in K + , Cre, and eGFR were significant in the first-MRB cohort, while they were not significant in the conversion cohort. Conclusions: Esaxerenone was safe for hypertensive patients with HFrEF. Hyperkalemia and hypotension were rarely noted while eGFR was significantly reduced. Moreover, esaxerenone was effective for HFrEF with respect to BNP levels.