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依普利酮与三氯噻嗪对血压控制不佳的高血压患者的家庭血压降低效果:EXCITE-HT随机对照试验按基础钙通道阻滞剂与血管紧张素受体阻滞剂进行的预定义亚组分析

Home blood pressure-lowering effect of esaxerenone versus trichlormethiazide for uncontrolled hypertension: a predefined subanalysis of the EXCITE-HT randomized controlled trial by basal calcium channel blocker versus angiotensin receptor blocker.

作者信息

Kario Kazuomi, Ohbayashi Hiroyuki, Hashimoto Masami, Itabashi Naoki, Kato Mitsutoshi, Uchiyama Kazuaki, Hirano Kunio, Nakamura Noriko, Miyamoto Takahide, Nagashima Hirotaka, Ishida Hidenori, Ebe Yusuke, Hatta Tsuguru, Fukui Toshiki, Shimosawa Tatsuo, Katsuya Tomohiro, Taguchi Takashi, Tanabe Ayumi, Ohishi Mitsuru

机构信息

Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.

Tohno Chuo Clinic, Mizunami, Gifu, Japan.

出版信息

Hypertens Res. 2025 Feb;48(2):506-518. doi: 10.1038/s41440-024-01887-1. Epub 2024 Oct 12.

Abstract

This prespecified subanalysis of the multicenter, randomized, open-label, parallel-group EXCITE-HT study aimed to examine the non-inferiority of esaxerenone to trichlormethiazide as a second-line antihypertensive agent according to the basal antihypertensive agent used (angiotensin receptor blocker [ARB] or calcium channel blocker [CCB]). The primary endpoint, change in morning home systolic/diastolic blood pressure (SBP/DBP) from baseline to end of treatment was similar between the two groups (intergroup difference in least squares mean change [95% confidence interval]: -1.3 [-3.8, 1.3]/-0.2 [-1.6, 1.3] mmHg for ARB; -2.7 [-4.2, -1.2]/-0.8 [-1.7, 0.1] mmHg for CCB). The respective incidences of serum potassium levels <3.5 mEq/L and ≥5.5 mEq/L in the ARB subgroup were 3.4% and 4.2% for esaxerenone and 7.9% and 0% for trichlormethiazide; in the CCB subgroup, they were 2.8% and 0.6% for esaxerenone and 13.9% and 1.2% for trichlormethiazide, respectively. The incidence of uric acid level ≥7.0 mg/dL was numerically higher in the trichlormethiazide group than the esaxerenone group in both the ARB and CCB subgroups. The non-inferiority of esaxerenone to trichlormethiazide in lowering morning home BP was demonstrated regardless of whether the basal antihypertensive agent was an ARB or CCB. Esaxerenone with a CCB showed superiority to trichlormethiazide in lowering SBP, without any new safety concerns. Serum potassium levels tended to be higher when esaxerenone was combined with an ARB than with a CCB, but this can be mitigated if administered according to the package insert. A subgroup analysis of the EXCITE-HT study according to basal antihypertensive agent demonstrated the non-inferiority of esaxerenone to trichlormethiazide in lowering morning home BP regardless irrespective of the basal antihypertensive agent. Esaxerenone with a CCB showed superiority to trichlormethiazide in lowering SBP, without any new safety concerns.

摘要

这项对多中心、随机、开放标签、平行组EXCITE-HT研究的预先设定的亚组分析旨在根据使用的基础抗高血压药物(血管紧张素受体阻滞剂[ARB]或钙通道阻滞剂[CCB]),检验依沙贝隆作为二线抗高血压药物相对于三氯噻嗪的非劣效性。主要终点,即从基线到治疗结束时早晨家庭收缩压/舒张压(SBP/DBP)的变化在两组之间相似(最小二乘均值变化的组间差异[95%置信区间]:ARB组为-1.3[-3.8,1.3]/-0.2[-1.6,1.3]mmHg;CCB组为-2.7[-4.2,-1.2]/-0.8[-1.7,0.1]mmHg)。在ARB亚组中,血清钾水平<3.5mEq/L和≥5.5mEq/L的依沙贝隆组发生率分别为3.4%和4.2%,三氯噻嗪组为7.9%和0%;在CCB亚组中,依沙贝隆组分别为2.8%和0.6%,三氯噻嗪组为13.9%和1.2%。在ARB和CCB亚组中,三氯噻嗪组尿酸水平≥7.0mg/dL的发生率在数值上均高于依沙贝隆组。无论基础抗高血压药物是ARB还是CCB,依沙贝隆在降低早晨家庭血压方面相对于三氯噻嗪的非劣效性均得到证实。依沙贝隆与CCB联合使用在降低SBP方面优于三氯噻嗪,且无任何新的安全性问题。当依沙贝隆与ARB联合使用时,血清钾水平往往高于与CCB联合使用时,但如果按照药品说明书给药,这种情况可以得到缓解。根据基础抗高血压药物对EXCITE-HT研究进行的亚组分析表明,无论基础抗高血压药物如何,依沙贝隆在降低早晨家庭血压方面相对于三氯噻嗪具有非劣效性。依沙贝隆与CCB联合使用在降低SBP方面优于三氯噻嗪,且无任何新的安全性问题。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9be1/11794140/ae4af0e5550f/41440_2024_1887_Figa_HTML.jpg

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