Esaxerenone improves vascular function, peripheral arterial stiffness in IHA patients

Patients with idiopathic hyperaldosteronism (IHA) treated with esaxerenone show improved vascular function and reduced peripheral arterial stiffness, reports a study.

Treatment with esaxerenone increased flow-mediated vasodilation from 3.1 percent to 5.7 percent (p<0.01) and nitroglycerine-induced vasodilation (NID) from 10.7 percent to 15.7 percent (p<0.01) and reduced brachial-ankle pulse wave velocity (baPWV) from 1,605 to 1,428 cm/s (p<0.01). However, its use did not significantly alter the brachial artery intima-media thickness (bIMT).

Changes in FMD and NID following esaxerenone use were significantly associated with changes in plasma aldosterone concentration (PAC) and plasma renin activity (PRA). In addition, the change in baPWV significantly correlated with changes in PRA, aldosterone-to-renin ratio, and systolic blood pressure.

“These findings suggest aldosterone inhibition is a potential mechanism governing improvement in cardiovascular health,” the authors said.

This single-centre, observational prospective cohort study included 44 patients with IHA (mean age 52 years, 26 women) enrolled from Hiroshima University Hospital. The authors measured vascular function, including FMD and NID, and peripheral arterial stiffness, including baPWV and bIMT, before and after 12 weeks of treatment with esaxerenone.

“Primary aldosteronism is one of the most common types of secondary endocrine hypertension,” according to the authors. “Treatment with mineralocorticoid receptor antagonists is recommended for bilateral IHA.”