CHINESE JOURNAL OF DRUG EVALUATION >

2026 , Vol. 43 >Issue 3: 205 - 205-209

DOI: https://doi.org/10.2095-3593.2026.050007

Application Status of Finerenone in Resistant Hypertension

Expand
  • Department of Basic Medicine， Guizhou Health Vocational College， Guizhou Tongren 554300， China

Received date: 2026-01-13

  Revised date: 2026-03-24

  Accepted date: 2026-05-19

  Online published: 2026-08-12

Fold

Abstract

Finerenone is a third-generation non-steroid mineralocorticoid receptor antagonist (MRA). Compared with the first two generations of steroidal MRAs， it has higher receptor selectivity and a lower risk of hyperkalemia and sex hormone-related adverse reactions. It possesses multiple cardiovascular protective effects， including lowering blood pressure， anti-inflammatory， antioxidant stress， anti-myocardial fibrosis improving insulin resistance， ventricular remodeling and cardiac function. For patients with resistant hypertension complicated by type 2 diabetes mellitus or chronic kidney disease， finerenone not only exhibits a definite antihypertensive effect and good safety profile， but also brings significant cardiorenal protection benefits. Its antihypertensive effect in treating primary aldosteronism is comparable to that of spironolactone， and the incidence of adverse drug reactions is lower. When used in combination with sodium-glucose co-transporter 2 inhibitors or tripterygium glycosides， it exhibits better renal protective effects on diabetic nephropathy without increasing the risk of adverse reactions. This article reviews the clinical research on finerenone for resistant hypertension， in order to provide a reference for its clinical application.

Key words： ; font-size:medium; ">Finerenone； Resistant hypertension； Mineralocorticoid receptor antagonist

Cite this article

ZHANG Ping . Application Status of Finerenone in Resistant Hypertension[J]. CHINESE JOURNAL OF DRUG EVALUATION, 2026 , 43(3) : 205 -205-209 . DOI: 10.2095-3593.2026.050007

References

 [1] NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019： a pooled analysis of 1201 population-representative studies with 104 million participants[J]. Lancet， 2021， 398(10304)：957-980.
     [2] Carey RM， Calhoun DA， Bakris GL， et al. Resistant hypertension： detection， evaluation， and management： a scientific statement from the American Heart Association[J]. Hypertension， 2018， 72(5)：e53-e90.
     [3] 《难治性高血压血压管理中国专家共识》撰写工作组. 难治性高血压血压管理中国专家共识[J]. 中华高血压杂志，2024，32(8)：700-709.
     [4] Sierra ADL， Ruilope LM， Staplin N， et al. Resistant hypertension and mortality：an observational cohort study[J]. Hypertension， 2024， 81(11)：e1-e9.
     [5] Ebinger JE， Gluckman TJ， Magraner J， et al. Characterization of individuals with apparent resistant hypertension using contemporary guidelines： insights from CV-QUIC[J]. Hypertension， 2023， 80(9)：e101-e110.
     [6] Taler SJ， Textor SC， Augustine JE. Resistant hypertension：comparing hemodynamic management to specialist care[J]. Hypertension， 2002， 39(5)：982-988.
     [7] Brown JM， Siddiqui M， Calhoun DA， et al. The unrecognized prevalence of primary aldosteronism： a cross-sectional study[J]. Ann Intern Med， 2020， 173(1)：10-20.
     [8] Calhoun DA， Nishizaka MK， Zaman MA， et al. Hyperaldosteronism among black and white subjects with resistant hypertension[J]. Hypertension， 2002， 40(6)：892-896.
     [9] Gaddam KK， Nishizaka MK， Pratt-Ubunama MN， et al. Characterization of resistant hypertension： association between resistant hypertension， aldosterone， and persistent intravascular volume expansion[J]. JAMA Intern Med， 2008， 168(11)：1159-1164.
     [10] Freeman MS， Halvorsen YD， Marshall W， et al. Phase 2 trial of baxdrostat for treatment-resistant hypertension[J]. N Engl J Med， 2023， 388(5)：395-405.
     [11] Calhoun DA， Booth JN， Oparil S， et al. Refractory hypertension：determination of prevalence， risk factors， and comorbidities in a Large， population-based cohort[J]. Hypertension， 2014， 63(3)：589-596.
     [12] Dudenbostel T， Acelajado MC， Pisoni R， et al. Refractory hypertension： evidence of heightened sympathetic activity as a cause of antihypertensive treatment failure[J]. Hypertension， 2015， 66(1)：126-133.
     [13] Velasco A， Siddiqui M， Kreps E， et al. Refractory hypertension is not attributable to intravascular fluid retention as determined by intracardiac volumes[J]. Hypertension， 2018， 72(2)：343-349.
     [14] Zannad F， McMurray JJ， Krum H， et al. Eplerenone in patients with systolic heart failure and mild symptoms[J]. N Engl J Med， 2011， 364(1)：11-21.
     [15] Kolkhof P， Delbeck M， Kretschmer A， et al. Finerenone， a novel selective nonsteroidal mineralocorticoid receptor antagonist protects from rat cardiorenal injury[J]. J Cardiovasc Pharmacol， 2014， 64(1)：69-78.
     [16] Bakris GL， Agarwal R， Chan JC， et al. Effect of finerenone on albuminuria in patients with diabetic nephropathy： a randomized clinical trial[J]. JAMA， 2015， 314(9)：884-894.
     [17] Bakris GL， Agarwal R， Anker SD， et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes[J]. N Engl J Med， 2020， 383(23)：2219-2229.
     [18] Pitt B， Filippatos G， Agarwal R， et al. Cardiovascular events with finerenone in kidney disease and type 2 diabetes[J]. N Engl J Med， 2021， 385(23)：2252-2263.
     [19] Wang Y， Li X， Zhang L， et al. Finerenone improves ventricular remodeling and cardiac function in hypertensive rats via IRE1 modulation of XBP1 and TRAF2[J]. J Hypertens， 2025， 43(11)：2245-2254.
     [20] Liu C， Yang M， Li L， et al. A glimpse of inflammation and anti-inflammation therapy in diabetic kidney disease[J]. Front Physiol， 2022， 13：909569.
     [21] Li ZH， Sun ZJ， Tang SCW， et al. Finerenone alleviates over-activation of complement C5a-C5aR1 axis of macrophages by regulating G protein subunit alpha i2 to improve diabetic nephropathy[J]. Cells， 2025， 14(5)：337.
     [22] Kaufmann E， Degenne R， Jourdan M， et al. Differential effects of losartan and finerenone on diabetic remodeling， oxidative stress and ACE activity in the gastrointestinal tract of streptozotocin-induced diabetic rats[J]. Int J Mol Sci， 2025， 26(19)：6294.
     [23] Gueret P， Harouki N， Favre J， et al. Vascular smooth muscle mineralocorticoid receptor contributes to coronary and left ventricular dysfunction after myocardial infarction[J]. Hypertension， 2016， 67(4)：717-723.
     [24] Pollard CM， Suster MS， Cora N， et al. GRK5 is an essential corepressor of the cardiac mineralocorticoid receptor and is selectively induced by finerenone[J]. World J Cardiol， 2022， 14(4)：220-230.
     [25] Jin T， Fu X， Liu M， et al. Finerenone attenuates myocardial apoptosis， metabolic disturbance and myocardial fibrosis in type 2 diabetes mellitus[J]. Diabetol Metab Syndr， 2023， 15(1)：87.
     [26] Gadve Sharcil S， Gadve Sneha S， Gadve Shriya， et al. Effect of finerenone on resistant hypertension in type 2 diabetes mellitus—a randomized controlled trial in indian population[J]. Diabetes， 2024， 73（Suppl）：878.
     [27] Agarwal R， Filippatos G， Pitt B， et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease： the FIDELITY pooled analysis[J]. Eur Heart J， 2022， 43(6)：474-484.
     [28] Agarwal R， Pitt B， Palmer BF， et al. A comparative post hoc analysis of finerenone and spironolactone in resistant hypertension in moderate-to-advanced chronic kidney disease[J]. Clin Kidney J， 2023， 16(5)：799-807.
     [29] Pitt B， Agarwal R， Kovesdy CP， et al. Patiromer versus placebo to enable spironolactone use in patients with resistant hypertension and chronic kidney disease (AMBER)： a phase 2， randomised， double-blind， placebo-controlled trial[J]. Lancet， 2019， 394(10207)：1517-1528.
     [30] Agarwal R， Kolkhof P， Bakris G， et al. Steroidal and non-steroidal mineralocorticoid receptor antagonists in cardiorenal medicine[J]. Eur Heart J， 2021， 42(2)：152-161.
     [31] Kolkhof P， Jaisser F， Kim SY， et al. Steroidal and novel non-steroidal mineralocorticoid receptor antagonists in heart failure and cardiorenal diseases： comparison at bench and bedside[J]. Handb Exp Pharmacol， 2017， 243：271-305.
     [32] Li G， Xu W， Li C， et al. Primary aldosteronism： pharmacotherapy vs surgery vs embolization efficacy–systematic review and network meta-analysis of studies predominantly conducted in China[J]. Front Endocrinol， 2025， 16：1645279.
     [33] Monticone S， D′Ascenzo F， Moretti C， et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension： a systematic review and meta-analysis[J]. Lancet Diabetes Endocrinol， 2018， 6(1)：41-50.
     [34] Li P， Yang F， Wang L， et al. Efficacy and safety of finerenone in patients with primary aldosteronism： a multicenter prospective study[J]. Hypertension， 2026， 83（5）：26048.
     [35] Li S， Zhang H， Wang J， et al. Efficacy and safety of finerenone in the treatment of primary aldosteronism： a prospective clinical study[J]. Diabetes Metab Syndr， 2026， 20（1）：103369.
     [36] Hu JB， Zhang XY， Li WH，et al. Efficacy and safety of finerenone in patients with primary aldosteronism： a pilot randomized controlled trial[J]. Circulation， 2025， 151(2)：196-198.
     [37] 周岐鑫. 非奈利酮与螺内酯治疗原发性醛固酮增多症的疗效及安全性比较：一项先导性研究[D]. 重庆：重庆医科大学，2025.
     [38] Fernández-Ruiz I. Finerenone improves outcomes in HFmrEF and HFpEF[J]. Nat Rev Cardiol， 2024， 21(11)：739.
     [39] Ang M， Henderson AD， Talebi A， et al. Effect of finerenone on the KCCQ in patients with HFmrEF/HFpEF： a prespecified analysis of FINEARTS-HF[J]. J Am Coll Cardiol， 2025， 85(2)：120-136.
     [40] Jhund PS， Talebi A， Henderson AD， et al. Mineralocorticoid receptor antagonists in heart failure： an individual patient level meta-analysis[J]. Lancet， 2024， 404(10458)：1119-1131.
     [41] Koeche C， Nogueira ACC， Amaral GPDS， et al. Cost-Effectiveness of mineralocorticoid receptor antagonists in ischemic and nonischemic heart failure with reduced ejection fraction： perspective from a universal healthcare system[J]. Value Health Reg Issues， 2025， 47：101084.
     [42] 张硕，赵英丽. 非奈利酮对射血分数降低型心力衰竭MR/TGF-β/Smads通路及心肌纤维化进程的影响[J]. 淮海医药，2026，44(1)：73-77.
     [43] Desai NR， Navaneethan SD， Nicholas SB， et al. Design and rationale of FINEREAL： a prospective study of finerenone in clinical practice[J]. J Diabetes Complications， 2023， 37(4)：108411.
     [44] Zhou L， Li W. Effectiveness and safety of finerenone in Chinese CKD patients without diabetes： a retrospective， real-world study[J]. Int Urol Nephrol， 2024， 56(12)：3877-3885.
     [45] 李静芳. 非奈利酮联合达格列净对糖尿病肾病患者肾功能及免疫功能的影响[J]. 齐齐哈尔医学院学报，2026，47(4)：322-326.
     [46] 廖世冲，龙军颖，易志钢，等. 非奈利酮联合达格列净对糖尿病肾病患者肾功能、炎症因子水平的影响[J]. 中国医学创新，2026，23(6)：23-28.
     [47] 蒋玲，彭丽，赵丽丽，等. 非奈利酮联合恩格列净治疗对糖尿病肾病患者肾功能及血清IGF-1、 MCP-1等指标水平的影响[J]. 微循环学杂志，2025，35(4)：74-77，83.
     [48] 新成，李瑞民，崔书霞. 雷公藤多苷联合非奈利酮治疗糖尿病肾病的有效性与安全性[J]. 中国药房，2026，37(4)：486-490.
Options
Outlines

/

〈 〉

[an error occurred while processing this directive]