Finerenone a viable option in primary aldosteronism treatment

The novel nonsteroidal mineralocorticoid receptor antagonist finerenone appears safe and efficacious in the treatment of primary aldosteronism, as shown in a study.

The study included 57 patients (age ≤75 years) with primary aldosteronism, an office blood pressure (BP) of 140–180/90–120 mm Hg, and an estimated glomerular filtration rate of ≥60 mL/min per 1.73 m². These patients received treatment with finerenone (20–40 mg per day) for 12 weeks.

Change in daytime systolic BP at 12 weeks was assessed as the primary outcome.

In the per-protocol analysis, finerenone treatment was associated with a significant reduction in mean daytime systolic BP (−6.69 mm Hg; p<0.001) and diastolic BP (−4.55 mm Hg; p<0.001), measured using ambulatory monitoring.

Greater reductions were observed in mean office systolic and diastolic BP (−15.58 and −8.61 mm Hg, respectively; p<0.001 for both).

Serum potassium concentration increased by a mean of 0.39±0.05 mmol/L, and the percentage of patients who had concentrations within the normal range increased from 61.8 percent at baseline to 94.5 percent after 12 weeks of treatment (p<0.001). Plasma renin activity also increased, with 32.7 percent of patients having a plasma renin activity concentration ≥1 ng/mL per h.

Based on the Primary Aldosteronism Medical Treatment Outcome criteria, 29.1 percent of patients achieved complete biochemical response, and 20 percent achieved clinical response. Treatment was well tolerated.