The Association of Finerenone Use and Cardiovascular Events in Hypertension

High blood pressure, or hypertension, is a significant health issue affecting more than a billion adults worldwide. It is the leading cause of heart and kidney problems. In the United States, it's the second most common cause of kidney failure. Detecting high blood pressure early and managing it effectively can help prevent heart and kidney diseases from getting worse. Most people with high blood pressure have primary hypertension, which means there is no clear underlying cause. However, in around 15–30% of cases, it is linked to underlying problems with hormones or the kidneys. One such hormone is aldosterone. When the body produces too much aldosterone, it can cause blood pressure to rise.

Steroidal mineralocorticoid receptor antagonists (MRA) are a class of medications used to treat difficult-to-control high blood pressure. They work by blocking the effects of aldosterone. Aldosterone has been shown to cause injury to blood vessels with high blood pressure leading to kidney and heart disease. A new type of these medications, non-steroidal MRA, have been shown to reduce the risk of heart and kidney failure in people with pre-existing heart failure and chronic kidney disease by blocking the effect of aldosterone. However, these new medication have not been studied in those with high blood pressure alone. Our previous meta-analysis (a statistical technique where data from multiple studies are combined in order to gain a more precise conclusion than can be gained from a single study) indicates that the non-steroidal MRA, Finerenone, can potentially reduce risk of death and other cardiovascular outcomes, such as hospitalisation for heart failure and chronic kidney disease progression, in people with high blood pressure and coexisting conditions like diabetes, heart failure or chronic kidney disease. The aim of this study is to investigate the use of Finerenone in people with a diagnosis of high blood pressure and its effect on death and cardiovascular disease to determine if its benefit extends to this group of patients.

This research will be conducted by analysing data from two large clinical trials – FIDELIO-DKD and FIGARO-DKD. We will include all participants with a diagnosis of hypertension at the start of these trials, to determine if use of Finerenone will reduce the risk of death and other cardiovascular outcomes in these people. The results of this study could help doctors and public health experts make better plans to prevent heart and kidney disease and improve treatment guidelines for people with high blood pressure worldwide.