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Age-stratified efficacy and safety of esaxerenone versus angiotensin II receptor blockers in older patients with hypertension: a predefined subanalysis of the ESCORT-HT study

Kazuomi Kario, Hiroyuki Ohbayashi, Hajime Ishii, Mitsutoshi Kato, Minoru Nozaki, Norio Abiru, Toshiki Fukui, Kazushi Nomura, Yasushi Fukushima, Naoki Itabashi, Kazuaki Uchiyama, Masafumi Nishizawa, Yoshiki Hata, Noriko Nakamura, Satoshi Kodono, Kunio Hirano, Tomohiro Katsuya, Tatsuo Shimosawa, Mitsuru Ohishi, Kazuhito Shiosakai, Taketoshi Furugori, Takashi Taguchi, on behalf of the ESCORT-HT investigators, Kazuomi Kario, Toshimitsu Kitajima, Tomohiro Katsuya, Toshiki Fukui, Mitsutoshi Kato, Minoru Nozaki, Kunio Hirano, Tetsuo Nishikawa, Kazuaki Uchiyama, Soichi Kurioka, Hirotaka Nagashima, Tsuguru Hatta, Yoshiki Hata, Takahide Miyamoto, Naoki Itabashi, Hiroshi Ohtani, Hiroyuki Ohbayashi, Kumie Ito, Masami Hashimoto, Hiroyuki Yamada, Yoshito Inobe, Kenji Yamauchi, Hajime Ishii, Masafumi Nishizawa, Yusuke Ebe, Noriko Nakamura, Daishiro Yamada, Kazuhisa Maeda, Hiroshi Kikuchi, Yuichiro Nakamura, Katsuhiko Yoshida, Toshihiko Yasuda, Katsuaki Okubo, Norio Abiru, Kota Yamada, Masahiro Ono, Satoshi Kodono, Ryohei Hisaki, Hiroshi Morinaga, Hideki Tanaka, Tsuyoshi Yamaguchi, Takashi Udagawa, Hiroyoshi Kanemitsu, Takehiro Nakamura, Hiroto Tamaru, Kazushi Nomura, Yasushi Fukushima, Toru Arino, Kenei Shimada, Tsuyoshi Yamato, Arihiro Kiyosue

DOI10.1038/s41440-026-02757-8

PublisherSpringer Science and Business Media LLC

Journal / SourceHypertension Research

Published2026-10-10

Metadata Deposited2026-10-09 (updated: 2026-10-09)

Subject—

Languageen

ISSN0916-9636, 1348-4214

Typejournal-article

Volume / Issue / Pages— / — / —

Citations0

References deposited38

Access / license metadataOpen license identified License 1 ↗A reuse license does not by itself establish whether the full text is freely readable.

Abstract

Abstract The ESCORT-HT study recently demonstrated non-inferiority of esaxerenone to angiotensin II receptor blockers (ARBs) in lowering morning home systolic blood pressure (SBP) in Japanese patients aged ≥65 years with inadequately controlled hypertension on amlodipine. This predefined subgroup analysis of the ESCORT-HT study analyzed age-related differences in the efficacy and safety of esaxerenone relative to ARBs. In the 65–74-year subgroup, 98 patients were treated with esaxerenone and 94 with an ARB; in the ≥75-year subgroup, 104 were treated with esaxerenone and 106 with an ARB. The least squares mean difference in morning home SBP between the two treatment groups at end of treatment was −1.1 (95% confidence interval [CI] −3.8, 1.6) mmHg for the 65–74-year subgroup and −2.2 (95% CI −5.2, 0.9) mmHg for the ≥75-year subgroup. The upper bound of the 95% CI was within the pre-defined non-inferiority margin of <3.8 mmHg. The urine albumin-to-creatinine ratio decreased in all groups at Week 12, regardless of age or treatment, and N-terminal pro-B-type natriuretic peptide levels decreased in esaxerenone-treated patients, regardless of age. The incidence of treatment-emergent adverse events was 34.3% (esaxerenone) and 32.0% (ARB) in patients 65–74 years, and 16.7% and 29.6%, respectively, in patients aged ≥75 years. There were no notable increases in the incidence of hyperkalemia or hypokalemia, relative to ARBs, in any of the age subgroups. This predefined subgroup analysis of the ESCORT-HT study showed antihypertensive effects consistent with the non-inferiority of esaxerenone to ARBs in both age groups, and suggested a potential cardioprotective effect, including for patients aged ≥75 years.

Open DOI