Efficacy and safety of esaxerenone vs trichlormethiazide for the treatment of uncontrolled essential hypertension in Japanese patients with type 2 diabetes mellitus: a subanalysis of the EXCITE-HT study

This subgroup analysis of the randomized, open-label, parallel-group EXCITE-HT study explored the antihypertensive efficacy and safety of esaxerenone vs trichlormethiazide in patients with type 2 diabetes mellitus (T2DM), stratified by baseline antihypertensive agent (angiotensin receptor blocker [ARB] or calcium channel blocker [CCB]) and urinary albumin-to-creatinine ratio (UACR; <30 or ≥30 mg/gCr). Using thresholds consistent with those used in the main study to interpret the difference in systolic/diastolic blood pressure (SBP/DBP), the between-group difference in least squares mean change (95% confidence interval [CI]) in morning home SBP/DBP at the end of treatment was -2.5 (-4.8, -0.2)/ - 0.7 (-2.0, 0.6) mmHg. Trends were consistent across all subgroups. The geometric mean UACR significantly decreased from baseline to Week 12 in the overall population, ARB subgroup (except for esaxerenone-treated patients), CCB subgroup, and both UACR subgroups. The overall incidence of serum potassium ≥5.5 mEq/L was 2.5% with esaxerenone and 0.9% with trichlormethiazide, with no cases of serum potassium ≥6.0 mEq/L. In this patient population, esaxerenone had a favorable safety profile, achieved blood pressure lowering similar to trichlormethiazide, and elicited a reduction of kidney damage (based on UACR), regardless of baseline antihypertensive agent or UACR.