TOPLINE

Finerenone resulted in early and sustained reductions in systolic blood pressure (BP) in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). The drug consistently reduced cardiovascular death and total HF events irrespective of baseline BP, and these benefits appeared independent of its BP-lowering effects.

METHODOLOGY

• Researchers conducted a prespecified secondary analysis of the FINEARTS-HF randomized controlled trial to evaluate the BP-lowering effects of finerenone and whether baseline BP modified cardiovascular outcomes in patients with HFmrEF/HFpEF.
• A total of 5999 participants with recorded baseline systolic BP were included (mean age, 72 years; 45% women; mean systolic BP, 129 mm Hg), who were randomly assigned to receive finerenone or placebo.
• The primary outcome was a composite of total (first and recurrent) HF events (HF hospitalizations and urgent HF visits) and cardiovascular death.

TAKEAWAY

• Finerenone produced sustained reductions in systolic BP compared with placebo, with most treatment effects observed by 1 month (mean difference −2.8 mm Hg; P < .001) and maintained through 36 months (overall treatment effect −3.1 mm Hg; P < .001).
• Higher final finerenone doses were associated with greater overall reduction in placebo-adjusted systolic BP reduction (10 mg: −1.5 mm Hg; 20 mg: −3.0 mm Hg; 40 mg: −4.0 mm Hg; P interaction = .003).
• Finerenone consistently reduced cardiovascular death and total HF events compared with placebo irrespective of baseline systolic and diastolic BP, with no significant modification by baseline BP category.
• The systolic BP effects of finerenone did not appear to significantly mediate the benefit of finerenone vs placebo on cardiovascular death and first HF events (percentage mediation 7.4%; 95% CI, −0.7 to 27.0).

IN PRACTICE

"This FINEARTS-HF analysis supports the use of finerenone to improve cardiovascular outcomes across a broad BP spectrum in HFmrEF/HFpEF," wrote the authors of the study.

SOURCE

The study was led by John W. Ostrominski, MD, MPH, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston. It was published online on July 8 in JAMA Cardiology.

LIMITATIONS

The analysis lacked 24-hour ambulatory BP monitoring. Exclusion criteria relating to BP and kidney function may limit the generalizability of these findings to broader patient populations.

DISCLOSURES

The FINEARTS-HF trial was supported by Bayer AG. Many of the authors declared receiving personal fees, research grants, consulting fees, and serving on advisory boards or having speaker engagements with multiple pharmaceutical companies, including the funding agency. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.