Last updated August 24, 2026
Key finding
The between-group difference in least squares mean change in morning home SBP was -2.5 (-4.8, -0.2) mmHg.
This study compared the antihypertensive efficacy and safety of esaxerenone and trichlormethiazide in patients with type 2 diabetes mellitus.
Quick read
The essential study design details in one scan.
EvidenceScore™
Moderate
Study type
RCTs
Follow-up
Extended (5–20+ y)
Risk of bias
High Risk
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Plain-language summary
A plain-language read of the study’s main message and where it applies.
Study focus
This study compared the antihypertensive efficacy and safety of esaxerenone and trichlormethiazide in patients with type 2 diabetes mellitus.
Understanding the comparative effectiveness and safety of these antihypertensive medications is crucial for managing hypertension in patients with type 2 diabetes. The findings suggest that while esaxerenone may be more effective in lowering blood pressure, clinicians should monitor potassium levels closely to prevent potential complications.
The study's population may not be representative of all patients with type 2 diabetes. The sample size and duration may limit the generalizability of the findings. Potential confounding factors were not fully controlled for in the analysis.
Published in
Publication details and source links for this paper.
Mitsuru O, Kazuomi K, Tomohiro K, et al. Antihypertensive efficacy and safety of esaxerenone vs trichlormethiazide in patients with type 2 diabetes mellitus: a subgroup analysis of the EXCITE-HT study. Hypertension Research. 2025;49(2):444-456. doi:10.1038/s41440-025-02437-z
Esaxerenone reduced morning home systolic blood pressure by -2.5 mmHg compared to trichlormethiazide.
Esaxerenone led to a -0.7 mmHg decrease in morning home diastolic blood pressure.
The incidence of serum potassium levels ≥5.5 mEq/L was 2.5% in the esaxerenone group versus 0.9% in the trichlormethiazide group.
Evidence network
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This study contributes evidence to Esaxerenone, Trichlormethiazide and Diastolic blood pressure, Incidence of serum potassium ≥5.5 mEq/L, Systolic blood pressure, and 1 more.
This study contributes evidence to
Primary intervention
Esaxerenone
Primary outcomes
Primary intervention
Intervention and outcome relationships this study adds to the evidence network.
Editorial context
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Evidence network role
This section describes how the study fits into the current evidence network. It does not determine whether an intervention works on its own.
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Related topics
8
Evidence pairs
0
Related studies
Core evidence
The primary outcomes reported in this study.
Esaxerenone → Diastolic blood pressure
Esaxerenone → Diastolic blood pressure
Esaxerenone → Incidence of serum potassium ≥5.5 mEq/L
Esaxerenone → Incidence of serum potassium ≥5.5 mEq/L
Esaxerenone → Urinary albumin-to-creatinine ratio
Esaxerenone → Urinary albumin-to-creatinine ratio
Trichlormethiazide → Diastolic blood pressure
Trichlormethiazide → Diastolic blood pressure
Trichlormethiazide → Incidence of serum potassium ≥5.5 mEq/L
Trichlormethiazide → Incidence of serum potassium ≥5.5 mEq/L
Trichlormethiazide → Systolic blood pressure
Trichlormethiazide → Systolic blood pressure
Trichlormethiazide → Urinary albumin-to-creatinine ratio
Trichlormethiazide → Urinary albumin-to-creatinine ratio
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Relationships organized using the Dediabetes Evidence Intelligence™ framework.
This study contributes to evidence on Trichlormethiazide and Blood Pressure, Trichlormethiazide and Blood Pressure.
This study contributes to the evidence on the following intervention-outcome relationships.
Medications
Medications
Curated evidence collections and hubs this study is part of.
All studies measuring Blood Pressure
Measures Blood Pressure as a key outcome.
All studies on Trichlormethiazide
Contributes to Trichlormethiazide evidence base.
All studies on Esaxerenone
Contributes to Esaxerenone evidence base.
All studies measuring Incidence of serum potassium ≥5.5 mEq/L
Measures Incidence of serum potassium ≥5.5 mEq/L as a key outcome.
Latest published studies
Published within the last 2 years.
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2 results
2 results
2 results
1 results
2 results
Generated from the study's connected evidence using Evidence Intelligence™.
Trichlormethiazide appears to improve Diastolic blood pressure.
ConsistencyScore™: Results are consistent across studies.
Ranked evidence signals
Diastolic blood pressure
EvidenceScore™ Moderate | EvidenceScore™ 69.0 | strong positive | ConsistencyScore™ Consistent | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
Trichlormethiazide appears to improve Systolic blood pressure.
ConsistencyScore™: Results are consistent across studies.
Ranked evidence signals
Systolic blood pressure
EvidenceScore™ Moderate | EvidenceScore™ 69.0 | strong positive | ConsistencyScore™ Consistent | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
Esaxerenone appears to improve Diastolic blood pressure.
ConsistencyScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
Diastolic blood pressure
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
Esaxerenone appears to improve Systolic blood pressure.
ConsistencyScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
Systolic blood pressure
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
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