Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Clinical Development Department III, R&D Division, Daiichi Sankyo Co., Ltd., 1-2-58, Hiromachi, Shinagawa-ku, Tokyo, 140-8710, Japan.
Hypertens Res. 2021 Apr;44(4):371-385. doi: 10.1038/s41440-020-00569-y. Epub 2020 Nov 20.
The nonsteroidal mineralocorticoid receptor (MR) blocker esaxerenone has demonstrated good antihypertensive activity in a variety of patients, including those with uncomplicated grade I-III hypertension, hypertension with moderate renal dysfunction, hypertension with type 2 diabetes mellitus with albuminuria, and hypertension associated with primary aldosteronism. Hyperkalemia has long been recognized as a potential side effect occurring during treatment with MR blockers, but there is a lack of understanding and guidance about the appropriate management of hyperkalemia during antihypertensive therapy with MR blockers, especially in regard to the newer agent esaxerenone. In this article, we first highlight risk factors for hyperkalemia, including advanced chronic kidney disease, diabetes mellitus, cardiovascular disease, age, and use of renin-angiotensin-aldosterone system inhibitors. Next, we examine approaches to prevention and management, including potassium monitoring, diet, and the use of appropriate therapeutic techniques. Finally, we summarize the currently available data for esaxerenone and hyperkalemia. Proper management of serum potassium is required to ensure safe clinical use of MR blockers, including awareness of at-risk patient groups, choosing appropriate dosages for therapy initiation and dosage titration, and monitoring of serum potassium during therapy. It is critical that physicians take such factors into consideration to optimize MR blocker therapy in patients with hypertension.
非甾体类盐皮质激素受体（MR）阻滞剂依普利酮在多种患者中表现出良好的降压活性，包括单纯 I-III 级高血压、中重度肾功能不全相关高血压、伴蛋白尿的 2 型糖尿病相关高血压和原发性醛固酮增多症相关高血压。高钾血症一直被认为是 MR 阻滞剂治疗期间潜在的副作用，但对于 MR 阻滞剂降压治疗期间高钾血症的适当管理，尤其是对于新型药物依普利酮，缺乏了解和指导。本文首先强调了高钾血症的危险因素，包括晚期慢性肾脏病、糖尿病、心血管疾病、年龄和肾素-血管紧张素-醛固酮系统抑制剂的使用。接下来，我们探讨了预防和管理方法，包括血钾监测、饮食和适当的治疗技术。最后，我们总结了依普利酮和高钾血症的现有数据。为确保 MR 阻滞剂的安全临床应用，需要对血清钾进行适当的管理，包括了解高风险患者群体、为起始治疗和剂量滴定选择合适的剂量、以及在治疗期间监测血清钾。医生必须考虑这些因素，以优化高血压患者的 MR 阻滞剂治疗。
