Key result
Selective aldosterone synthase inhibitors lower SBP by ~9 mmHg vs placebo in uncontrolled primary hypertension.
Why the study?
Do selective aldosterone synthase inhibitors reduce systolic blood pressure in adults with uncontrolled primary hypertension?
Meta-Analysis (n=2,456)
Do selective aldosterone synthase inhibitors reduce systolic blood pressure in adults with uncontrolled primary hypertension?
Selective aldosterone synthase inhibitors significantly reduce blood pressure in uncontrolled hypertension but increase the risk of hyperkalemia, hypotension, hyponatremia, and eGFR reduction.
Supports use with monitoring for hyperkalemia and renal effects; confirms efficacy of aldosterone synthase inhibitors in uncontrolled hypertension.
= 0.036). The certainty of evidence was high for both SBP and mild hyperkalemia, and moderate for moderate to severe hyperkalemia. Selective ASIs appear to be a promising treatment in terms of efficacy and safety for uncontrolled hypertensive patients. Larger RCTs with extended follow-up periods are warranted to establish long-term evidence. Trial Registration: PROSPERO Identifier: CRD420251108664.
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Louat et al. (2025) conducted a meta-analysis in Uncontrolled primary hypertension (n=2,456). Selective aldosterone synthase inhibitors (ASIs) vs. Placebo was evaluated on Difference in least-squares mean (LSMD) of systolic blood pressure (SBP) (LSMD -9.05 mmHg, 95% CI -10.98 to -7.12, p=<0.001). Selective aldosterone synthase inhibitors significantly reduced systolic blood pressure compared to placebo in patients with uncontrolled primary hypertension, with a least-squares mean difference of -9.05 mmHg for standard-dose regimens.
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