{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:02:13Z","timestamp":1784696533932,"version":"3.55.0"},"reference-count":23,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background\/Objectives: Esaxerenone is a non-steroidal mineralocorticoid receptor antagonist (MRA) with potent cardiorenal protective effects. However, the clinical effects of switching from eplerenone to esaxerenone in patients with chronic heart failure complicated by hypertension remain unclear. This study investigated the effects of switching from eplerenone to esaxerenone on blood pressure, heart failure biomarkers, renal function, and the renin\u2013angiotensin\u2013aldosterone system (RAAS). Methods: A total of 156 patients with chronic heart failure and hypertension who had been receiving eplerenone for more than one year were prospectively enrolled. Eplerenone was switched to esaxerenone, and the patients were followed for 6 months. Blood pressure, heart rate, brain natriuretic peptide (BNP), renal function, urinary albumin-to-creatinine ratio (UACR), plasma renin activity (PRA), plasma aldosterone concentration (PAC), and urinary osmolality (U-OSM) were evaluated. Results: Following the switch to esaxerenone, systolic and diastolic blood pressure significantly decreased (both p &lt; 0.001), whereas heart rate remained unchanged. BNP levels significantly decreased at 3 and 6 months (p = 0.008 and p = 0.002, respectively). Serum creatinine decreased (p = 0.017), estimated glomerular filtration rate increased (p = 0.028), and UACR significantly decreased at both time points (both p &lt; 0.001). PRA and PAC significantly increased after switching (both p &lt; 0.05), whereas angiotensin II levels remained unchanged. U-OSM significantly decreased (p = 0.01 and p = 0.002 at 3 and 6 months, respectively). No major cardiovascular events or severe adverse events were observed. Conclusions: In patients with chronic heart failure and hypertension, switching from eplerenone to esaxerenone was associated with reductions in blood pressure, BNP, UACR, and urinary osmolality, together with improvements in renal function. These findings suggest favorable physiological changes following the switch from a steroidal to a non-steroidal mineralocorticoid receptor antagonist, although confirmation in randomized controlled studies with clinical outcome measures is warranted.<\/jats:p>","DOI":"10.3390\/jpm16070388","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T16:19:27Z","timestamp":1784564367000},"page":"388","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiorenal Effects of Switching from Eplerenone to Esaxerenone in Patients with Chronic Heart Failure and Hypertension: A Prospective Clinical Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3474-9082","authenticated-orcid":false,"given":"Akira","family":"Sezai","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo 173-8610, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9156-5415","authenticated-orcid":false,"given":"Masanori","family":"Abe","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Maruyama","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Taoka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo 173-8610, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisakuni","family":"Sekino","sequence":"additional","affiliation":[{"name":"Sekino Hospital, Tokyo 171-0014, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi-Kamicho, Itabashi-Ku, Tokyo 173-8610, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1056\/NEJM199909023411001","article-title":"The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure","volume":"341","author":"Pitt","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1161\/HYPERTENSIONAHA.109.140988","article-title":"Efficacy of Spironolactone Therapy in Patients with True Resistant Hypertension","volume":"55","author":"Muxfeldt","year":"2010","journal-title":"Hypertension"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1056\/NEJMoa030207","article-title":"Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction","volume":"348","author":"Pitt","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa1009492","article-title":"Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms","volume":"364","author":"Zannad","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.1056\/NEJMoa2025845","article-title":"Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes","volume":"383","author":"Bakris","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2252","DOI":"10.1056\/NEJMoa2110956","article-title":"Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes","volume":"385","author":"Pitt","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1056\/NEJMoa2407107","article-title":"Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction","volume":"391","author":"Solomon","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.ejphar.2015.11.028","article-title":"CS-3150, a novel non-steroidal mineralocorticoid receptor antagonist, prevents hypertension and cardiorenal injury in dahl salt-sensitive hypertensive rats","volume":"769","author":"Arai","year":"2015","journal-title":"Eur. J. Pharmacol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1038\/s41371-020-0377-6","article-title":"Esaxerenone, a novel nonsteroidal mineralocorticoid receptor blocker (MRB) in hypertension and chronic kidney disease","volume":"35","author":"Wan","year":"2021","journal-title":"J. Hum. Hypertens."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1007\/s40265-019-01073-5","article-title":"Esaxerenone: First global approval","volume":"79","author":"Duggan","year":"2019","journal-title":"Drugs"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Sezai, A., Abe, M., Maruyama, T., Taoka, M., Sekino, H., and Tanaka, M. (2025). A Prospective Crossover Clinical Trial of Esaxerenone and Eplerenone in Patients with Chronic Heart Failure Complicated by Hypertension. Life, 15.","DOI":"10.3390\/life15050741"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1161\/HYPERTENSIONAHA.119.13569","article-title":"Double-blind randomized phase 3 study comparing esaxerenone (CS-3150) and eplerenone in patients with essential hypertension (ESAX-HTN Study)","volume":"75","author":"Ito","year":"2020","journal-title":"Hypertension"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1093\/ajh\/hpaa155","article-title":"Effect of the nonsteroidal mineralocorticoid receptor blocker, esaxerenone, on nocturnal hypertension: A post hoc analysis of the ESAX-HTN study","volume":"34","author":"Kario","year":"2021","journal-title":"Am. J. Hypertens."},{"key":"ref_14","first-page":"220","article-title":"Emerging Roles of the Mineralocorticoid Receptor in Pathology","volume":"12","author":"Jaisser","year":"2016","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1093\/eurheartj\/16.suppl_N.103","article-title":"Aldosterone escape during ACE inhibitor therapy in chronic heart failure","volume":"16","author":"Struthers","year":"1995","journal-title":"Eur. Heart J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.cardiores.2003.11.037","article-title":"Review of aldosterone-and angiotensin II-induced target organ damage and prevention","volume":"61","author":"Struthers","year":"2004","journal-title":"Cardiovasc. Res."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Qiang, P., Hao, J., Yang, F., Han, Y., Chang, Y., Xian, Y., Xiong, Y., Gao, X., Liang, L., and Shimosawa, T. (2022). Esaxerenone inhibits the macrophage-to-myofibroblast transition through mineralocorticoid receptor\/TGF-\u03b21 pathway in mice induced with aldosterone. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.948658"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1007\/s10157-021-02075-y","article-title":"Efficacy and safety of esaxerenone (CS-3150) in Japanese patients with type 2 diabetes and macroalbuminuria: A multicenter, single-arm, open-label phase III study","volume":"25","author":"Ito","year":"2021","journal-title":"Clin. Exp. Nephrol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1038\/s41440-022-01008-w","article-title":"The renoprotective effect of esaxerenone independent of blood pressure lowering: A post hoc mediation analysis of the ESAX-DN trial","volume":"46","author":"Okuda","year":"2023","journal-title":"Hypertens. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1093\/eurheartj\/ehi145","article-title":"Vasopressin antagonism: A future treatment option in heart failure","volume":"26","author":"Sanghi","year":"2005","journal-title":"Eur. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1253\/circrep.CR-21-0115","article-title":"Implication of mineralocorticoid receptor antagonist esaxerenone in patients with heart failure with preserved ejection fraction","volume":"3","author":"Imamura","year":"2021","journal-title":"Circ. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1038\/s41440-020-00606-w","article-title":"Efficacy and safety of esaxerenone in patients with hypertension and concomitant heart failure","volume":"44","author":"Naruke","year":"2021","journal-title":"Hypertens. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1253\/circrep.CR-25-0070","article-title":"Rationale and Design of the ESPIAL Trial\u2014A Prospective, Randomized, Exploratory Study to Evaluate the Effect of Esaxerenone on Reduction of Urinary Albumin to Creatinine Ratio in Hypertensive Patients Concomitant with Heart Failure and Albuminuria","volume":"7","author":"Suna","year":"2025","journal-title":"Circ. Rep."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/7\/388\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:11:45Z","timestamp":1784693505000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/7\/388"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":23,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jpm16070388"],"URL":"https:\/\/doi.org\/10.3390\/jpm16070388","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]}}}