Javed Butler, MD, MPH, MBA

Butler explains why the urine albumin-to-creatinine ratio belongs in routine heart failure risk assessment and where the open questions remain.

Javed Butler, MD, MBA, discusses how aldosterone synthase inhibition could shift treatment across heart failure, CKD, and resistant hypertension.

The discussion concludes with strategies to overcome access barriers and ensure equitable implementation of novel HFpEF therapies.

Panelists address adherence challenges and the need for careful coordination when integrating nonsteroidal MRAs into multifaceted treatment plans.

Experts highlight preventive approaches, including risk factor control and early therapeutic intervention, to mitigate HFpEF development.

Discussion centers on combining MRAs with other agents while maintaining vigilant monitoring to minimize risks and optimize long-term management.

Panelists share insights on how best to sequence MRAs, SGLT2 inhibitors, and ARNis to maximize patient outcomes and adherence.

The panel focuses on balancing efficacy and safety when choosing MRAs for patients with HFpEF with complex comorbid conditions such as CKD and diabetes.

Experts discuss the clinical implications of finerenone’s benefits and forecast how upcoming guidelines may shift standard care practices.

The group reviews key findings from FINEARTS-HF and discusses how finerenone’s approval expands treatment options for patients with HFpEF.

Panelists explore the mechanistic benefits of aldosterone antagonism and its evolving role within HFpEF therapeutic frameworks.

The conversation compares the efficacy and safety of nonsteroidal and steroidal MRAs, focusing on clinical decision-making and patient selection.

Experts examine how updated guidelines are influencing the integration of novel MRAs and other agents into HFpEF treatment algorithms.

Panelists emphasize strategies to enhance patient quality of life and reduce hospital readmissions through optimized therapeutic management.

The discussion centers on proactive screening and early intervention approaches to improve outcomes and slow HFpEF progression.

Experts highlight the importance of precise diagnostic criteria and multimodal assessments to distinguish HFpEF from overlapping cardiovascular conditions.

Panelists discuss how evolving diagnostic precision, evidence-based MRA use, and combination therapy strategies are transforming HFpEF care while addressing real-world challenges in access and adherence.

This set of interviews collects perspectives from 11 leading clinicians in the heart failure field, cataloguing the biggest news from 2025.

Cohosts Stephen Greene, MD, and Muthiah Vaduganathan, MD, MPH, sit down with Javed Butler, MD, to discuss the results of this major trial.

Panelists discuss how improving adherence requires both individual strategies like smartphone reminders and smart medication monitoring devices, as well as population-level interventions including reducing sodium content in processed foods and harmonizing hypertension guidelines to address the epidemic of poorly controlled blood pressure.

Panelists discuss how newer therapies will likely be incorporated into guidelines with improved reimbursement structures over time, similar to the evolution seen with lipid-lowering medications, making advanced treatments more accessible for patients with uncontrolled blood pressure.

Panelists discuss how follow-up strategies should include monthly visits initially with more frequent monitoring for high-risk situations, emphasizing home blood pressure monitoring and utilizing team-based care approaches with optimal visit intervals of 4 to 6 weeks to avoid both therapeutic inertia and overadjustment.

Panelists discuss how shared decision-making requires explaining the rationale for blood pressure control, addressing patient fears about medications, and utilizing newer drug classes like endothelin receptor antagonists that offer a “clean slate” approach for patients who have had negative experiences with traditional therapies.

Panelists discuss how medication reduction is occasionally possible in well-controlled patients over time, particularly with diuretics when sodium intake decreases or calcium channel blockers to reduce edema, while being cautious about maintaining adequate blood pressure control and avoiding drugs that worsen kidney function.

Panelists discuss how aggressive blood pressure targets below 130 mm Hg (preferably 120 mm Hg) should be pursued in most resistant hypertension patients using combination therapies, while individualizing goals based on patient age, tolerability, and comorbidities.

Panelists discuss how to sequence fourth-line treatments for resistant hypertension, with spironolactone remaining first choice for most patients with normal renal function, while newer endothelin receptor antagonists offer advantages for patients with chronic kidney disease or those intolerant to aldosterone antagonists.

Panelists discuss how the PRECISION trial subanalysis showed aprocitentan worked equally well in Black patients as in White patients, which is particularly important given the higher prevalence and complications of resistant hypertension in Black populations, with emphasis on adequate diuretic management to prevent peripheral edema.

Panelists discuss how the PRECISION trial demonstrated aprocitentan’s efficacy in lowering blood pressure by nearly 15 mm Hg within 4 weeks in resistant hypertension patients, including those with advanced chronic kidney disease, with durable effects and minimal adverse effects except for manageable peripheral edema.

Panelists discuss how endothelin receptor antagonism addresses resistant hypertension by blocking one of the most potent vasoconstrictors, reducing smooth muscle hypertrophy and fibrosis, with aprocitentan being the only endothelin receptor antagonist approved for resistant hypertension.

Panelists discuss how standard ACE therapy leaves multiple pathways unblocked in resistant hypertension, with spironolactone being the most evidence-based fourth-line therapy despite limitations, while emerging therapies target sympathetic nervous system overactivity, aldosterone excess, and endothelin-mediated vasoconstriction.