Finerenone and Empagliflozin Combination in Obesity With Hypertension: A 12-Week Prospective, Parallel-design, Double-blind, Randomized, Placebo-controlled Trial

• Empagliflozin and Finerenone (Drug): This is a fixed-dose combination of two oral medications-empagliflozin (a sodium-glucose cotransporter 2 inhibitor) and finerenone (a nonsteroidal mineralocorticoid receptor antagonist)-administered simultaneously as separate tablets once daily for 12 weeks. The intervention consists of empagliflozin 10 mg once daily plus finerenone 10 mg once daily, taken orally in the morning with or without food.
• Placebo for Empagliflozin and Finerenone (Drug): Participants receive two matching placebo tablets orally once daily in the morning, with or without food, for 12 weeks: one placebo matching empagliflozin 10 mg and one placebo matching finerenone 10 mg. Both placebos are identical in appearance, size, shape, color, and taste to the corresponding active study drugs to ensure complete double-blinding.

Primary outcomes

• Change in Unattended Office Systolic Blood Pressure From Baseline to Week 12 [Baseline (Day 1) to Week 12 (visit 5, end-of-treatment visit)]

Secondary outcomes

• Change in Unattended Office Diastolic Blood Pressure From Baseline to Week 12 [Baseline (Day 1) to Week 12 (visit 5)]
• Change in Cumulative Blood Pressure Exposure From Baseline to Week 12 [Baseline (Day 1) to Week 12 (visit 5)]
• Change in Log-Transformed Urinary Albumin-to-Creatinine Ratio From Baseline to Week 12 [Baseline (Day 1) to Week 12 (visit 5)]
• Change in High-Sensitivity C-Reactive Protein From Baseline to Week 12 [Baseline (Day 1) to Week 12 (visit 5)]
• Change in Fasting Plasma Glucose From Baseline to Week 12 [Baseline (Day 1) to Week 12 (visit 5)]
• Change in Body Weight From Baseline to Week 12 [Baseline (Day 1) to Week 12 (visit 5)]
• Change in EQ-5D Quality of Life Score From Baseline to Week 12 [Baseline (Day 1) to Week 12 (visit 5)]
• Proportion of Participants Achieving Strict Blood Pressure Control at Week 12 [Week 12 (visit 5)]
• Proportion of Participants With SBP >160 mmHg or Initiation of Additional Antihypertensive Therapy Within 12 Weeks [Baseline (Day 1) through Week 12 (visit 5)]

Sex: All, ages: 40 Years to any

Inclusion Criteria:

Age ≥ 40 years.

Body mass index (BMI) ≥ 28 kg/m² or abdominal obesity, defined as meeting any of the following:

Waist circumference ≥ 90 cm (male) or ≥ 85 cm (female); Waist-to-hip ratio ≥ 0.9 (male) or ≥ 0.85 (female); Waist-to-height ratio ≥ 0.5. Unattended office systolic blood pressure (SBP) ≥ 140 mmHg and < 160 mmHg during the screening period (within 1 week before randomization).

Currently taking no more than 2 antihypertensive agents (fixed-dose combinations are counted by the number of active ingredients).

No changes in the type or dose of antihypertensive medications within 4 weeks before the screening visit.

Provide written informed consent.

Exclusion Criteria:

Diastolic blood pressure ≥ 100 mmHg. Diagnosed diabetes mellitus or fasting plasma glucose ≥ 7.0 mmol/L. History of heart failure (any ejection fraction) or left ventricular ejection fraction < 50%.

Acute coronary syndrome, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG) within 90 days.

Stroke or transient ischemic attack (TIA) within 90 days. Known secondary hypertension (e.g., bilateral renal artery stenosis >75%, aldosteronism, pheochromocytoma), except documented sleep apnea.

Severe hepatic dysfunction (AST/ALT > 3× upper limit of normal, or Child-Pugh class C).

Acute kidney injury within 6 months before screening, or eGFR < 60 mL/min/1.73 m², or kidney transplant (or planned).

Primary adrenal insufficiency (Addison's disease). Contraindications to any component of the study drugs (e.g., urinary tract infection within 90 days, serum potassium > 5.0 mmol/L, drug allergy).

Major surgery under general anesthesia within 90 days before screening, or elective surgery planned within 90 days after screening.

Gastrointestinal surgery or disease that, in the investigator's judgment, may affect absorption of the study drug.

Pregnancy, lactation, or planned pregnancy (for both male and female participants) during the study period.

Active malignancy. Life expectancy < 3 months. Use of strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) or inducers (e.g., rifampicin, carbamazepine, phenytoin) that cannot be discontinued within 7 days before Day 1.

Use of mineralocorticoid receptor antagonists (e.g., finerenone, eplerenone, spironolactone), renin inhibitors, SGLT2 inhibitors (e.g., dapagliflozin, empagliflozin), or SGLT-1/2 inhibitors (e.g., canagliflozin) within 8 weeks before screening or during the intervention period.

Use of potassium supplements, potassium-sparing diuretics (e.g., amiloride, triamterene), or potassium-binding agents within 8 weeks before screening or during the intervention period.

Participation in a clinical trial of empagliflozin or finerenone within 1 month before screening.

Current use of weight-loss medications (e.g., GLP-1 receptor agonists, GIP/GLP-1 dual agonists, GLP-1/GCGR dual agonists) or prior/planned bariatric surgery.

Known or suspected orthostatic hypotension or autonomic dysfunction. Any condition that, in the investigator's opinion, makes the participant unsuitable for the study.

• Xin Du, Principal investigator, Beijing Anzhen Hospital