Implication of Mineralocorticoid Receptor Antagonist Esaxerenone in Patients with HFpEF

Abstract

<h3>Purpose</h3> The implications of mineralocorticoid receptor antagonists, including the newly-introduced esaxerenone, on cardiac reverse remodeling in patients with HFpEF remain uncertain. <h3>Methods</h3> We retrospectively included patients with HFpEF who received esaxerenone for resistant hypertension between Nov 2019 and Jul 2021. Changes in left ventricular mass index (LVMI) were compared between the six-month pre-treatment period (without esaxerenone) and the six-month treatment period (on esaxerenone). <h3>Results</h3> Thirty-three patients (median age 74 [70, 81] years, 33% men, systolic blood pressure 135 [123, 148] mmHg) were included and completed 6-month esaxerenone therapy without any adverse events. During the pre-treatment period, systolic blood pressure decreased significantly (p = 0.009) whereas LVMI remained unchanged (p = 0.30; Figure 1). During the treatment period with esaxerenone, both systolic blood pressure and LVMI decreased significantly (p = 0.003 and p = 0.001, respectively). <h3>Conclusion</h3> Esaxerenone may have beneficial effects of reverse remodeling in patients with HFpEF when used to treat hypertension. Further studies are needed to understand which patient populations may see greater benefits.