Hypertension trial compares drug responses with and without diabetes
A single peer-reviewed subgroup analysis compared two added treatments in older Japanese patients whose hypertension remained above a home-measurement threshold on amlodipine. Blood pressure fell in patients with and without type 2 diabetes, but treatment differences remained uncertain. Urinary protein measurements changed over twelve weeks; these short-term biomarkers do not demonstrate lasting kidney protection. The open-label study was funded by Daiichi Sankyo.
Science··Evening
Two additional treatments in older patients
A single peer-reviewed paper presents a predefined subgroup analysis of ESCORT-HT, a randomized hypertension trial at 53 Japanese centres. Patients were at least 65 years old and continued amlodipine, a blood-pressure medicine, while receiving either esaxerenone or an angiotensin II receptor blocker. The trial was open-label, so treatment assignments were known. Division by type 2 diabetes gave groups of 65 and 55 patients with diabetes, and 135 and 145 without diabetes, for the two treatments respectively.[1]
Blood pressure falls, with uncertain treatment differences
Adjusted morning home systolic blood-pressure reductions were 10.9 millimetres of mercury with esaxerenone and 8.8 millimetres of mercury with the comparator in patients with diabetes. Without diabetes, the reductions were 10.5 millimetres of mercury and 9.1 millimetres of mercury respectively. Confidence intervals for the treatment differences included zero. The subgroup sizes were not separately calculated to establish non-inferiority, meaning that the added drug was no worse than the alternative within a specified margin. A formal treatment-by-diabetes interaction was not tested.[1]
Urinary protein and safety over twelve weeks
For the esaxerenone-treated diabetes group, a urinary protein indicator—the albumin-to-creatinine ratio—was 33.4 per cent lower at twelve weeks. This ratio tracks urinary protein loss, rather than a long-term kidney outcome. Baseline differences also limit comparisons between groups. In the esaxerenone group without diabetes, one potassium measurement reached or exceeded the threshold of 6.0 milliequivalents per litre. Eligibility criteria ruled out severe kidney dysfunction. Funding came from Daiichi Sankyo, which also helped design the study, interpret its data and prepare the paper. EPS handled statistical analysis and data management with funding from the company. Lasting cardiovascular or kidney benefits were not evaluated.[1]
