Finerenone and apparent treatment-resistant hypertension in heart failure with mildly reduced or preserved ejection fraction.

Abstract

Aims: Apparent treatment-resistant hypertension (aTRH) is common and associated with adverse outcomes in individuals with heart failure (HF) with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). Whether finerenone improves blood pressure (BP) and clinical outcomes in individuals with HFmrEF/HFpEF and aTRH is uncertain.

Methods: In this pre-specified analysis of the FINEARTS-HF trial, participants were categorized according to baseline BP, with aTRH defined as BP ≥140/90 mm Hg (≥130/80 mm Hg if diabetes) despite treatment with ≥3 BP-lowering medications, including a diuretic. Non-resistant hypertension was defined as BP above threshold but not meeting aTRH criteria. Controlled BP was defined as BP under the threshold. Incidence of clinical outcomes and safety events was assessed by baseline hypertension category.

Results: Among 6001 participants, 3471 (57.8%) had controlled blood pressure, 1754 (29.2%) had non-resistant hypertension, and 776 (12.9%) had aTRH at baseline. Between baseline and 36 months, finerenone similarly reduced systolic BP across baseline BP categories (Pinteraction = 0.59). Rates of cardiovascular death and total HF events (per 100 person-years) were 17.0 in those with controlled BP, 16.0 in those with non-resistant hypertension, and 13.8 in those with aTRH (Pcomparison = 0.12). Relative treatment benefits of finerenone vs placebo on the primary outcome (Pinteraction = 0.32) and HF-related health status (Pinteraction = 0.22) were consistent across hypertension categories. The safety profile of finerenone vs placebo did not appear to be modified by baseline hypertension category.

Conclusion: aTRH was identified in 1-in-8 individuals with HFmrEF/HFpEF in FINEARTS-HF. Finerenone consistently improved clinical outcomes, health status, and blood pressure, including among those with aTRH.