SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Pharmacoepidemiology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1664810
Efficacy and Safety of Aldosterone Synthase Inhibitors for Uncontrolled Hypertension: A Meta-Analysis of Randomized Controlled Trials and Systematic Review
Provisionally accepted
- Beijing University of Chinese Medicine, Beijing, China
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Background Uncontrolled hypertension is a major global health concern. Aldosterone synthase inhibitors (ASIs) show promise as a new treatment approach for blood pressure management. Methods A systematic review and meta-analysis were conducted on randomized controlled trials comparing ASIs versus placebo for uncontrolled hypertension. The search included PubMed, Cochrane Library, Web of Science, and Embase databases from inception to July 7, 2025, limited to English-language publications. Data extraction was performed independently by two authors. Results Four randomized controlled trials involving 1,838 patients (mean age 62 years; 47% female) were analyzed. The results demonstrated that ASIs significantly reduced office systolic blood pressure by 8.21 mm Hg (95% CI, -10.64 to -5.78; P<0.0001) and diastolic blood pressure by 3.64 mm Hg (95% CI, -5.65 to -1.63; P=0.0004). The risk ratio for adverse events was 1.42 (95% CI, 1.25-1.60; P<0.00001), with a similar trend observed for serious adverse events (risk ratio 1.17; 95% CI, 0.63-2.17; P=0.61). No treatment-related deaths occurred. However, ASIs were associated with a significantly higher risk of hyperkalemia (risk ratio 7.97; 95% CI, 2.27-27.99; P=0.001). Conclusions This is a provisional file, not the final typeset article ASIs significantly lower blood pressure in hypertensive patients with an acceptable safety profile, though hyperkalemia risk requires monitoring. These results suggest ASIs may be a viable hypertension treatment, but larger studies are needed.
Keywords: Uncontrolled hypertension, Aldosterone synthase inhibitors, Hyperkalemia, Blood Pressure reduction, Meta-analysis
Received: 12 Jul 2025; Accepted: 04 Sep 2025.
Copyright: © 2025 Gao, Mu and Pang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xingxue Pang, Beijing University of Chinese Medicine, Beijing, China
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