Avoiding Hyperkalemia Associated with Treatment of Resistant Hypertension

Resistant hypertension is prevalent among patients with advanced chronic kidney disease (CKD), and is associated with an increased likelihood of poor cardiovascular and renal outcomes. However, according to Bertram Pitt, MD, and colleagues, patients with advanced CKD are often not treated for resistant hypertension due to concerns regarding side effects, primarily hyperkalemia, associated with the currently available recommended add-on therapy, steroidal mineralocorticoid receptor antagonists (MRAs) such as spironolactone and eplerenone. KBP-5074 is a novel non-steroidal MRA that can treat resistant hypertension in patients with reduced kidney function without the risk of hyperkalemia.

In the journal Expert Opinion on Investigational Drugs [doi.org/10.1080/13543784.2021.1985462], the researchers provide a review of the current state of treatment for resistant hypertension in patients with stage 3B/4 CKD as it relates to available steroidal MRAs. The review also describes emerging data on nonsteroidal MRAs, including KBP-5074.

The review notes that in a randomized, double-blind, placebo-controlled phase 2b trial, KBP-5074 “demonstrated clinical efficacy and safety in treating resistant hypertension in stage 3B/4 CKD and offers a potential new treatment option in this population at high risk for cardiovascular disease and CKD progression.”