Elbahloul Mohammed A, Ali Ahmed Hamdy G, Al-Shammari Ali Saad, Labeeb Eman E, Attia Manar Khaled, Mansour Ahmed, Akoum Atef, Elazab Ahmed, Sattar Yasar, Lavie Carl J, Elgendy Islam Y
Faculty of Medicine, Kafr El-Shaikh University, Kafr El Shaikh, Egypt.
National Research Mordovia State University, Saransk, Mordovia, Russia.
J Hypertens. 2026 Apr 1;44(4):542-552. doi: 10.1097/HJH.0000000000004264. Epub 2026 Feb 2.
Resistant hypertension is a challenging condition and linked with considerable morbidity. We aimed to evaluate the efficacy and safety of aldosterone synthase inhibitors (ASIs) among patients with resistant hypertension. Four electronic databases were searched to identify randomized clinical trials (RCTs) evaluating ASIs compared with placebo for resistant hypertension. A frequentist network meta-analysis was conducted. Continuous outcomes were reported as mean differences and dichotomous outcomes as risk ratio, each with 95% confidence interval (95% CI), using a random-effect model. The primary outcomes were changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP). A total of 2725 patients from six RCTs were included. Baxdrostat and Lorundrostat significantly reduced SBP (Baxdrostat: MD -8.81 mmHg, 95% CI -10.94 to -6.67; Lorundrostat: MD -8.42 mmHg, 95% CI -11.05 to -5.78) and DBP (Baxdrostat: MD -3.28 mmHg, 95% CI -4.68 to -1.87; Lorundrostat: MD -3.13 mmHg, 95% CI -4.27 to -1.98). In contrast, Osilodrostat did not show a significant difference in SBP or DBP compared with placebo. Baxdrostat and Lorundrostat were associated with significant increases in serum potassium levels and hyperkalemia. None of the three drugs significantly increased the risk of serious adverse events. Highly selective ASIs (Baxdrostat and Lorundrostat) significantly lowered BP in patients with resistant hypertension without increasing the risk of serious adverse events, whereas the nonselective agent Osilodrostat did not reach significant difference. These findings suggest that selective aldosterone synthase inhibition represents a promising therapeutic option for resistant hypertension.
顽固性高血压是一种具有挑战性的病症，且与相当高的发病率相关。我们旨在评估醛固酮合酶抑制剂（ASIs）在顽固性高血压患者中的疗效和安全性。检索了四个电子数据库，以识别评估ASIs与安慰剂相比治疗顽固性高血压的随机临床试验（RCTs）。进行了频率学派网状荟萃分析。连续型结局以均值差报告，二分法结局以风险比报告，均采用随机效应模型并给出95%置信区间（95%CI）。主要结局为收缩压（SBP）和舒张压（DBP）的变化。纳入了来自六项RCTs的共2725例患者。巴多司他和洛伦司他显著降低了SBP（巴多司他：MD -8.81 mmHg，95%CI -10.94至-6.67；洛伦司他：MD -8.42 mmHg，95%CI -11.05至-5.78）和DBP（巴多司他：MD -3.28 mmHg，95%CI -4.68至-1.87；洛伦司他：MD -3.13 mmHg，95%CI -4.27至-1.98）。相比之下，奥西司他与安慰剂相比，在SBP或DBP方面未显示出显著差异。巴多司他和洛伦司他与血清钾水平显著升高和高钾血症相关。这三种药物均未显著增加严重不良事件的风险。高选择性ASIs（巴多司他和洛伦司他）在顽固性高血压患者中显著降低血压，且未增加严重不良事件的风险，而非选择性药物奥西司他未达到显著差异。这些发现表明，选择性醛固酮合酶抑制是治疗顽固性高血压的一种有前景的治疗选择。
