{
  "abstract": "Background: Apparent treatment-resistant hypertension (aTRH) is common in chronic kidney disease (CKD) with type 2 diabetes and predicts worse outcomes. Spironolactone, the established fourth-line agent, is limited by hyperkalemia in CKD. Objectives: This analysis assessed whether finerenone plus empagliflozin lowers blood pressure (BP) meaningfully in aTRH, and whether aTRH modifies these agents' efficacy and safety. Methods: Post hoc analysis of CONFIDENCE ( NCT05254002 ), a double-blind randomized trial of finerenone, empagliflozin, or both in CKD with albuminuria and type 2 diabetes. aTRH was BP ≥130/80 mm Hg on 3 antihypertensive drugs, or ≥4 drugs regardless of BP. Mixed models and logistic regression identified predictors of BP response. Results: Of the 796 participants, 307 (39%) had aTRH; they were older, more obese, and had more atherosclerotic cardiovascular disease, higher albuminuria, and higher systolic BP (140.9 vs 131.5 mm Hg) but similar estimated glomerular filtration rate (53 vs 55 mL/min/1.73 m 2 ). Combination therapy lowered systolic BP more than either monotherapy. Independent predictors of a ≥10 mm Hg systolic BP fall were aTRH (OR: 1.56; 95% CI: 1.08-2.25) and higher baseline estimated glomerular filtration rate (OR: 1.15 per 10 mL/min/1.73 m 2 ; 95% CI: 1.05-1.26); diuretic use and albuminuria were not. The aTRH effect was treatment-independent (interaction P = 0.21). Adverse events were more frequent with aTRH (63.8% vs 51.1%), yet on combination therapy hyperkalemia was less frequent (11.2% vs 17.5%). Conclusions: aTRH affected approximately 40% of participants and marked a higher-risk phenotype responsive to finerenone-empagliflozin, with BP reductions comparable to spironolactone but without the excess hyperkalemia that limits its use in CKD.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Nephrology, Richard L. Roudebush VA Medical Center & Indiana University School of Medicine, Indianapolis, Indiana, USA",
    "Section of Nephrology, Baylor College of Medicine, Houston, Texas, USA",
    "Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico",
    "Division of Nephrology and Kidney Health Research Collaborative, University of California, San Francisco, California, USA",
    "Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands",
    "Division of Endocrinology, Metabolism & Lipid Research, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA",
    "University of North Carolina Kidney Center, UNC School of Medicine, Chapel Hill, North Carolina, USA",
    "Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan",
    "Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA",
    "Steno Diabetes Center Copenhagen, Copenhagen, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark",
    "Division of Cardiovascular Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA",
    "Donald and Barbara Zucker School of Medicine, Hofstra/Northwell University, Hempstead, New York, USA",
    "Metabolic Institute of America, Tarzana, California, USA",
    "Division of Endocrinology, Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA",
    "KfH Kidney Centre, Munich, and Department of Nephrology & Hypertension, Friedrich Alexander University, Erlangen, Germany",
    "Clinical Statistics and Analytics, Bayer US LLC, Whippany, New Jersey, USA",
    "Global Medical Evidence, Bayer AG, Berlin, Germany",
    "Cardiology and Nephrology Clinical Development, Bayer AG, Germany",
    "Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 19,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Rajiv Agarwal, MD, MS"
    },
    {
      "affs": [
        1
      ],
      "name": "Sankar D. Navaneethan, MD, MS, MPH"
    },
    {
      "affs": [
        2
      ],
      "name": "Ricardo Correa-Rotter, MD"
    },
    {
      "affs": [
        3
      ],
      "name": "Michelle M. Estrella, MD, MHS"
    },
    {
      "affs": [
        4
      ],
      "name": "Hiddo J.L. Heerspink, PhD"
    },
    {
      "affs": [
        5
      ],
      "name": "Janet B. McGill, MD"
    },
    {
      "affs": [
        6
      ],
      "name": "Amy K. Mottl, MD"
    },
    {
      "affs": [
        7
      ],
      "name": "Masaomi Nangaku, MD, PhD"
    },
    {
      "affs": [
        8
      ],
      "name": "Julio Rosenstock, MD"
    },
    {
      "affs": [
        9
      ],
      "name": "Peter Rossing, MD"
    },
    {
      "affs": [
        10
      ],
      "name": "Muthiah Vaduganathan, MD, MPH"
    },
    {
      "affs": [
        11
      ],
      "name": "Javier Morales, MD"
    },
    {
      "affs": [
        12
      ],
      "name": "Yehuda Handelsman, MD"
    },
    {
      "affs": [
        13
      ],
      "name": "Jennifer B. Green, MD"
    },
    {
      "affs": [
        14
      ],
      "name": "Johannes F.E. Mann, MD"
    },
    {
      "affs": [
        15
      ],
      "name": "Charlie Scott, MSc"
    },
    {
      "affs": [
        16
      ],
      "name": "Li Li, MD, MBA"
    },
    {
      "affs": [
        17
      ],
      "name": "Meike Brinker, MD"
    },
    {
      "affs": [
        18
      ],
      "name": "Matthew R. Weir, MD"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/cv3dnncc6k804.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jacadv.2026.103388",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2772963X26008100",
  "id": "cv3dnncc6k804",
  "issns": [
    "2772-963X"
  ],
  "landing_url": "https://doi.org/10.1016/j.jacadv.2026.103388",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "lcc",
      "RC666-701"
    ],
    [
      "lcc",
      "RC86-88.9"
    ],
    [
      "openalex",
      "2705|Blood Pressure and Hypertension Studies"
    ]
  ],
  "openalex": "W7223295771",
  "pdf_url": null,
  "pmcid": "PMC13721014",
  "pmid": "42914747",
  "published": "2026-10-23",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/cv3dnncc6k804.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:44:58Z",
      "native_id": "d46d24df9d55420aab8a606669a937cb",
      "source": "doaj",
      "url": "https://doi.org/10.1016/j.jacadv.2026.103388"
    },
    {
      "first_seen": "2026-11-03T12:21:46Z",
      "native_id": "PMC13721014",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.jacadv.2026.103388"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Blood Pressure and Hypertension Studies",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Finerenone-Empagliflozin Combination Therapy in Apparent Resistant Hypertension",
  "title_text": "Finerenone-Empagliflozin Combination Therapy in Apparent Resistant Hypertension",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T12:21:46Z",
  "url": "https://research.draconitic.com/paper/cv3dnncc6k804",
  "venue": "JACC: Advances",
  "versions": []
}