Sezai Akira, Abe Msasnori, Maruyama Takashi, Taoka Makoto, Sekino Hisakuni, Tanaka Masashi
Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan.
Division of Nephrology, Hypertension, and Endocrinology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan.
Life (Basel). 2025 May 5;15(5):741. doi: 10.3390/life15050741.
Esaxerenone, which blocks aldosterone binding, is approved to treat hypertension but not heart failure. We aimed to understand esaxerenone's efficacy in treating chronic heart failure. This crossover study compared esaxerenone with eplerenone, an approved treatment for heart failure, in 66 patients with chronic heart failure complicated by hypertension (12 months for each drug). The primary endpoint was brain natriuretic peptide. The secondary endpoints included blood pressure; hormones and enzymes that regulate electrolytes and stress response; and biomarkers of kidney function. Change in brain natriuretic peptide concentration was significantly lower for esaxerenone compared with eplerenone at 3, 6, and 12 months. Blood pressure (all time points), plasma aldosterone concentration (3 and 6 months), and urinary albumin-to-creatinine ratio (3 and 6 months) were significantly lower for esaxerenone compared with eplerenone. The results suggest that esaxerenone more strongly blocks aldosterone binding than does eplerenone. This effect, together with its strong antihypertensive effect and reduced urinary albumin-to-creatinine ratio, suggests that esaxerenone improves kidney function. The results of this small-scale, single-center study need to be expanded to a larger-scale investigation, but esaxerenone shows promise as a treatment for chronic heart failure with hypertension.
依沙芦生酮可阻断醛固酮结合，已被批准用于治疗高血压，但未被批准用于治疗心力衰竭。我们旨在了解依沙芦生酮治疗慢性心力衰竭的疗效。这项交叉研究在66例合并高血压的慢性心力衰竭患者中，将依沙芦生酮与已被批准用于治疗心力衰竭的依普利酮进行了比较（每种药物治疗12个月）。主要终点是脑钠肽。次要终点包括血压；调节电解质和应激反应的激素和酶；以及肾功能生物标志物。在3个月、6个月和12个月时，依沙芦生酮组脑钠肽浓度的变化明显低于依普利酮组。与依普利酮相比，依沙芦生酮组的血压（所有时间点）、血浆醛固酮浓度（3个月和6个月）和尿白蛋白与肌酐比值（3个月和6个月）均显著降低。结果表明，依沙芦生酮比依普利酮更能有效地阻断醛固酮结合。这种作用，连同其强大的降压作用和降低的尿白蛋白与肌酐比值，表明依沙芦生酮可改善肾功能。这项小规模、单中心研究的结果需要扩大到更大规模的调查，但依沙芦生酮显示出作为治疗合并高血压的慢性心力衰竭的潜力。
