Finerenone was associated with higher rates of post-baseline systolic blood pressure (SBP) <100 mm Hg and investigator-reported hypotension and had no significant difference in treatment effect based on baseline kidney function, according to recent analyses of the FINEARTS-HF trial published in JACC: Heart Failure.

In the first study, Alberto Foà, MD, PhD, et al., looked at 5,815 trial participants, identifying predictors of SBP <100 mm Hg and hypotension. The primary outcome was a composite of total heart failure (HF) events and cardiovascular death.

Post-baseline SBP <100 mm Hg was observed in 899 participants (538 taking finerenone vs. 361 taking placebo; odds ratio: 1.60; 95% CI: 1.38–1.85) while investigator-reported hypotension was noted in 364 participants (228 taking finerenone vs. 139 taking placebo; odds ratio: 1.67; 95% CI: 1.34–2.08).

Overall, participants with SBP <100 mm Hg tended to have lower SBP at baseline, were older, had higher NT-proBNP levels, a history of smoking and lack of diabetes. The authors also found that “following hypotension, finerenone benefits were attenuated but appeared consistent among participants who were adherent to randomized treatment, suggesting that transient blood pressure lowering should not automatically prompt drug interruption.”

In the second study, Finnian R. Mc Causland, MBBCh, MMSc, et al., explored whether baseline kidney function influenced the impact of finerenone in reducing cardiovascular death and total HF events among FINEARTS-HF trial participants.

Participants randomized to the treatment group with estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m² received 20 mg/d of finerenone while those with eGFR >60 mL/min/1.73 m² received 40 mg/d.

Results showed no significant difference in the effect of finerenone according to baseline eGFR (P_interaction = 0.14 and 0.07 for continuous and categorical eGFR, respectively). Rate ratios for each of the eGFR categories (≥60 mL/min/1.73 m²; 45 to <60 mL/min/1.73 m²; <45 mL/min/1.73 m²) were 0.72, 0.83 and 1.02, respectively. Similarly, no significant difference was observed across baseline categories of urine albumin-creatinine ratio (UACR) (P_interaction = 0.48).

“Although absolute risks of hyperkalemia were amplified at lower eGFR, the risk of discontinuation due to [adverse events] was consistent across eGFR categories,” write the authors. “Given the overall favorable risk-to-benefit profile, baseline kidney function should not detract from the initiation of finerenone.”