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This 12-week, multicenter, randomized, open-label, parallel-group, non-inferiority ESCORT-HT study (jRCTs031240300; September 2024\u2013June 2025) compared esaxerenone with angiotensin II receptor blockers (ARBs) as add-on therapy to amlodipine in Japanese patients aged \u226565 years whose morning home systolic blood pressure (SBP) remained \u2265135\u2009mmHg despite stable amlodipine. The mean age was 75.5 years in both the esaxerenone (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009202; female: 52.5%) and ARB (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009200; female: 56.5%) groups. At the end of treatment, the least squares mean change from baseline in morning home SBP (primary endpoint) was \u221210.6 (95% confidence interval: \u221212.0, \u22129.1) mmHg with esaxerenone treatment and \u22129.0 (\u221210.4, \u22127.5) mmHg with ARB treatment; the between-group difference was \u22121.6 (\u22123.7, 0.5) mmHg, meeting the pre-defined non-inferiority margin (3.8\u2009mmHg). Both treatments lowered the\u00a0urine albumin-to-creatinine ratio, whereas only esaxerenone significantly reduced N-terminal pro-B-type natriuretic peptide. Treatment-emergent adverse events occurred in 25.1% and 30.8% of the esaxerenone and ARB groups; serious events were reported in 2 versus 7 patients, including one death (esaxerenone group). Hyperkalemia occurred in one esaxerenone-treated patient and none who received ARBs. No serious adverse event was judged to be drug-related. Esaxerenone was non-inferior to ARBs in lowering morning home SBP and showed a favorable safety profile in older Japanese patients with inadequately controlled hypertension on amlodipine. These data support the clinical use of esaxerenone as an effective second-line treatment option for this population.\n                  <\/jats:p>","DOI":"10.1038\/s41440-026-02634-4","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T09:18:10Z","timestamp":1777022290000},"page":"2240-2252","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Esaxerenone versus angiotensin II receptor blockers as second-line therapy in older Japanese patients with uncontrolled hypertension on calcium channel blockers: the randomized, open-label ESCORT-HT study"],"prefix":"10.1038","volume":"49","author":[{"given":"Kazuomi","family":"Kario","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Ohbayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajime","family":"Ishii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsutoshi","family":"Kato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minoru","family":"Nozaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norio","family":"Abiru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiki","family":"Fukui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazushi","family":"Nomura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Fukushima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Itabashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuaki","family":"Uchiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Nishizawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiki","family":"Hata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriko","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Kodono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunio","family":"Hirano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiro","family":"Katsuya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuo","family":"Shimosawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhito","family":"Shiosakai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Go","family":"Kato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Taguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuru","family":"Ohishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the ESCORT-HT investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"2634_CR1","doi-asserted-by":"publisher","first-page":"1344","DOI":"10.1038\/s41440-020-0508-z","volume":"43","author":"T Hisamatsu","year":"2020","unstructured":"Hisamatsu T, Segawa H, Kadota A, Ohkubo T, Arima H, Miura K. 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Hiroyuki Ohbayashi received research funding from Kracie, Ltd. and KYORIN Pharmaceutical Co., Ltd. Tomohiro Katsuya received honoraria from Daiichi Sankyo Co., Ltd., Novartis Pharma K.K., Otsuka Pharmaceutical Co., Ltd., and CureApp, Inc. Tatsuo Shimosawa received research funding from SFM Co. Ltd.; consulting fees from Sekisui Medical Co., Ltd. and EP Mediate Co., Ltd.; and honoraria from Daiichi Sankyo Co., Ltd., Novartis Pharma K.K., and Otsuka Pharmaceutical Co., Ltd. Kazuhito Shiosakai, Go Kato, and Takashi Taguchi are employees of Daiichi Sankyo Co., Ltd. Mitsuru Ohishi received honoraria from Daiichi Sankyo Co., Ltd. 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 had no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}