Key result
Finerenone reduces office SBP by ~3 mmHg vs placebo.
Why the study?
Optimal blood pressure control remains elusive for many patients due to resistant or secondary hypertension, and the direct impact of finerenone on blood pressure requires comprehensive evaluation.
Does finerenone reduce office systolic blood pressure compared to placebo in adults across varying cardiovascular and renal phenotypes?
Meta-Analysis (n=19,609)
Double-blind
Yes
Does finerenone reduce office systolic blood pressure compared to placebo in adults across varying cardiovascular and renal phenotypes?
Finerenone provides a modest but highly consistent reduction in systemic systolic blood pressure across multiple cardiorenal patient populations, acting as a mild hemodynamic modifier.
Answers are grounded in this paper and cite their sources.
Finerenone modestly lowers office SBP; confirms consistent BP effects across cardiorenal phenotypes and supports further outcome trials.
Background: Optimal blood pressure (BP) control remains elusive for millions of patients worldwide, often leading to resistant or secondary hypertension. Overactivation of the mineralocorticoid receptor (MR) drives this systemic pathology. While steroidal mineralocorticoid receptor antagonists (MRAs) are effective, their clinical utility is limited by poor cross-selectivity and risk of hyperkalemia. Finerenone, a novel non-steroidal MRA, offers high selectivity and potent target-organ protection, but a comprehensive pooling of its direct impact on BP is still needed. Methods: Following the PRISMA guidelines, a systematic search was conducted across PubMed, Embase, and ClinicalTrials.gov up to August 2026 for randomized controlled trials (RCTs) comparing finerenone versus placebo and reporting BP outcomes. The primary outcome was office systolic blood pressure (SBP). Results: Six RCTs involving 19,609 patients were included. Finerenone demonstrated a statistically significant but modest reduction in both office SBP (LSM difference: −2.83 mmHg; 95% CI: −3.15 to −2.51; p < 0.001) and office diastolic blood pressure (DBP) (LSM difference: −1.04 mmHg; 95% CI: −1.37 to −0.70; p < 0.001) compared with the placebo, with an absence of statistical heterogeneity (I2 = 0.00%). Subgroup analysis confirmed office SBP-lowering efficacy across different clinical phenotypes, including chronic kidney disease and heart failure (p for interaction = 0.18). In a small subset of patients, finerenone reduced 24-h ambulatory SBP (LSM difference: −7.88 mmHg; 95% CI: −10.94 to −4.82; p < 0.001), though these exploratory findings warrant caution due to the limited sample size; no significant reduction was observed for 24-h ambulatory DBP. Conclusions: Finerenone is associated with a modest but statistically significant reduction in systemic SBP.
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Marino et al. (2026) conducted a meta-analysis in Cardiometabolic and renal conditions (e.g., CKD, Heart Failure) (n=19,609). Finerenone vs. Placebo was evaluated on Office systolic blood pressure (SBP) (LSM difference -2.83 mmHg, 95% CI -3.15 to -2.51, p=<0.001). Finerenone demonstrated a statistically significant but modest reduction in office systolic blood pressure by 2.83 mmHg compared to placebo.
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