Finerenone-Empagliflozin Combination Therapy in Apparent Resistant Hypertension: A CONFIDENCE Trial Post Hoc Analysis
Authors' conclusion
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.
Study context
- Population
- Patients with chronic kidney disease (CKD) with albuminuria and type 2 diabetes, analysed by apparent treatment-resistant hypertension (aTRH)307 (39%) had aTRH · aTRH 307
- Participants
- 796 patients
- Comparison
- Finerenone, empagliflozin, or both; efficacy and safety by aTRH status
- aTRHn = 307
Primary result
As reported in the abstract
Systolic BP lowering
- Combination therapy lowered systolic blood pressure (BP) more than either monotherapy
Further findings
Predictors of a ≥10 mm Hg systolic BP fall
| Comparison | OR (95% CI) | |
|---|---|---|
| aTRHIndependent predictor; comparator not named in the abstract | 1.56 (1.08–2.25) | |
| 0.512Odds ratio (log scale) |
| Outcome | OR (per 10 mL/min/1.73 m²) (95% CI) | |
|---|---|---|
| Predictors of a ≥10 mm Hg systolic BP fallHigher baseline estimated glomerular filtration rate · independent predictor | 1.15 (1.05–1.26) | |
| 0.512Odds ratio (log scale) |
- Predictors of a ≥10 mm Hg systolic BP fall: The aTRH effect was treatment-independent (interaction P = 0.21)
Predictors of a ≥10 mm Hg systolic BP fall
- Diuretic use and albuminuria were not independent predictors
Baseline characteristics, aTRH vs no aTRH
- Systolic BP
- 140.9 vs 131.5 mm Hg
- Estimated glomerular filtration rate
- 53 vs 55 mL/min/1.73 m²
- Those with aTRH were older, more obese, and had more atherosclerotic cardiovascular disease and higher albuminuria
Safety
Adverse events
- Adverse events more frequent with aTRH
- 63.8% vs 51.1%
Hyperkalemia on combination therapy
- Hyperkalemia less frequent on combination therapy
- 11.2% vs 17.5%
Original publication
Finerenone-Empagliflozin Combination Therapy in Apparent Resistant Hypertension: A CONFIDENCE Trial Post Hoc Analysis. JACC Adv. Published 23 October 2026. doi:10.
Summarised from the published abstract; every number is checked against it