Effect of Finerenone on Ambulatory Blood Pressure in Chronic Kidney Disease in Type 2 Diabetes
J Hypertens. 2023;41:295–302 DOI: 10.1097/HJH.0000000000003330
It has been postulated that the effects of finerenone on cardiorenal outcomes may be mediated primarily via non-haemodynamic pathways, but office BP measurements are insufficient to fully assess haemodynamic effects. A substudy of the ARTS-DN phase IIb trial was conducted to obtain further insights into the mechanism of action of finerenone by analysing 24-h ambulatory BP in patients with CKD and T2D.
In the substudy, finerenone was found to have a modest and inconsistent effect in reducing office BP from baseline. In contrast, SBP assessed by 24-h ambulatory BP monitoring (ABPM) was significantly reduced from baseline with finerenone. Compared with placebo, finerenone also reduced daytime and night-time SBP similarly. Despite its short half-life, changes in BP with finerenone were persistent over 24 h with once-daily dosing in the morning.
The authors concluded that these haemodynamic effects provide a biological basis for greater incidence of hypotension, a lower incidence of hypertension and an early separation in curves of the time to first CV events seen with finerenone in phase III trials.