Evidence map›Paper›PMID 42625028›Full record

ArticleJournal of human hypertension2026

Cardiovascular events with esaxerenone versus spironolactone in hypertension.

Takashin Nakayama, Hidehiro Kaneko, Yuta Suzuki, Akira Okada, Hiroyuki Morita, Katsuhito Fujiu, Norifumi Takeda, Tatsuhiko Azegami, Takashi Yokoo, Norihiko Takeda and 3 more

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in Journal of human hypertension, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Takashin NakayamaDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Hidehiro KanekoDepartment of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan. kanekohidehiro@gmail.com.ORCID http://orcid.org/0000-0003-2553-6170
Yuta SuzukiDepartment of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Akira OkadaDepartment of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Hiroyuki MoritaDepartment of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Katsuhito FujiuDepartment of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Norifumi TakedaDepartment of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Tatsuhiko AzegamiDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Takashi YokooDivision of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.ORCID http://orcid.org/0000-0003-1838-7998
Norihiko TakedaDepartment of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Koichi NodeDepartment of Cardiovascular Medicine, Saga University, Saga, Japan.
Hideo YasunagaDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Kaori HayashiDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Mineralocorticoid receptor antagonists (MRAs) exhibit distinct pharmacologic profiles, yet their differential clinical relevance remains underexplored. This study assessed cardiovascular prevention with nonsteroidal esaxerenone (ESAX) relative to steroidal spironolactone (SPL) in hypertensive populations. From a nationwide claims database, we identified individuals with hypertension who newly initiated ESAX or SPL. Cardiovascular disease (CVD) was defined as a composite outcome of heart failure, atrial fibrillation, myocardial infarction, or stroke. We compared the incidence between the two groups using propensity score-based overlap weighting. A total of 5,960 individuals were included in the analysis: 3,776 who initiated ESAX and 2,184 SPL. The median (interquartile range) age was 73 (67-79) years, and 2,977 (50%) were men. The median estimated glomerular filtration rate was 66 (56-76) ml/min/1.73 m², and 1,210 (20%) had diabetes mellitus. During a median follow-up of 451 (208-816) days, 1,060 CVD events were observed. In weighted Cox regression, ESAX use was associated with a lower likelihood of developing CVD compared with SPL (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.70-0.91). This finding was mainly attributable to risk reductions in heart failure (HR, 0.80; 95% CI, 0.70-0.92) and atrial fibrillation (HR, 0.63; 95% CI, 0.44-0.91), with associations for myocardial infarction (HR, 0.97; 95% CI, 0.48-1.96) and stroke (HR, 0.88; 95% CI, 0.64-1.19) being non-significant. Our analysis showed a reduced incidence of CVD associated with ESAX, pointing to potential drug-specific differences within the MRA class.

Indexed as

Cardiovascular DiseasesHypertensionMineralocorticoid Receptor AntagonistsPyrrolesSpironolactoneAgedDatabases, FactualFemaleHumansIncidenceMalePropensity ScoreProportional Hazards ModelsRisk FactorsStrokeSulfonesesaxerenoneMineralocorticoid Receptor AntagonistsPyrrolesSpironolactoneSulfones

Identifiers

PMID42625028

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.