Effect of esaxerenone on nocturnal blood pressure and natriuretic peptide in different dipping phenotypes

Abstract

There are limited data on the nighttime blood pressure (BP)-lowering effect of esaxerenone and its effect on N-terminal pro b-type natriuretic peptide (NT-proBNP), a predictor of cardiovascular risk, according to different dipping patterns of nocturnal BP. This was a post hoc analysis of a multicenter, open-label, long-term phase 3 study of esaxerenone, a new highly selective mineralocorticoid receptor blocker, in patients with essential hypertension. Patients were classified by dipping pattern (extreme dippers, dippers, non-dippers, risers). Mean changes in BP, changes in dipping pattern, mean NT-proBNP levels, and percentage of patients with normal NT-proBNP levels (<55 pg/mL) at baseline and Weeks 12 and 28 were evaluated. Nighttime systolic BP decreased in all dipping pattern groups at Week 28, with the riser group showing the greatest change (-25.5 mmHg). A significant shift in dipping pattern and riser/non-dipper pattern changes to dipper/extreme dipper pattern were found from baseline to Week 28 (p < 0.0001). The prevalence of the riser pattern decreased from 14.4% to 9.8%, and that of the non-dipper pattern from 44.7% to 39.2%. The decrease in NT-proBNP from baseline to Week 28 was statistically significant in risers, non-dippers, dippers, and extreme dippers (p < 0.001, respectively). At baseline, the proportion of patients with NT-proBNP <55 pg/mL was lowest in risers versus the other dipping pattern types, but after reductions in NT-proBNP in all groups to Week 28, these differences disappeared. Long-term administration of esaxerenone may be a useful treatment option for nocturnal hypertension, especially in patients with a riser pattern.

Keywords: Blood pressure; Esaxerenone; Hypertension; Mineralocorticoid receptor antagonists; NT-proBNP.

Fig. 1

Mean change from baseline in blood pressure. Data are shown as mean ± 95% confidence intervals. The P values for the differences between groups (versus dippers): *p < 0.05, **p < 0.001. BP blood pressure, h hour

Fig. 2

Geometric mean change in NT-proBNP (A) and proportion of patients with NT-proBNP level <55 pg/mL (B). A: Data are shown as point estimates ± 95% confidence intervals. The p value versus baseline: **p < 0.001. B: The p values for the differences between groups (versus risers): *p < 0.05; and the p values on the top of the bar graphs were calculated by analysis of variance. NT-proBNP N-terminal pro b-type natriuretic peptide

Fig. 3

Graphical Abstract: Long-term administration of esaxerenone may be a useful treatment option for nocturnal hypertension, with improving NT-proBNP levels, especially in patients with a riser pattern