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논문분류	춘계학술대회 초록집
제목	Efficacy and Safety of Aldosterone Synthase Inhibitors in Uncontrolled Hypertension: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials
저자	Noha Hammad
출판정보	2026; 2026(1):
키워드	Aldosterone synthase inhibitors, Uncontrolled hypertension, Resistant hypertension, Network meta-analysis
초록	Objectives: Resistant and uncontrolled hypertension remains a major global health challenge and contributes to cardiovascular morbidity and mortality. Aldosterone synthase inhibitors (ASIs) are a novel class of antihypertensive drugs targeting CYP11B2, with potential benefits in treatment-resistant and uncontrolled hypertension. However, their comparative efficacy and safety remain uncertain. Methods: We systematically searched through PubMed, Scopus, Cochrane, and Web of Science (WOS) from inception to September 6, 2025, for randomized controlled trials (RCTs) evaluating ASIs versus placebo in adults with uncontrolled or treatment-resistant hypertension. The primary outcome was the change in office systolic blood pressure (OSBP). Secondary outcomes included changes in office diastolic blood pressure (ODBP), ambulatory SBP (ASBP), serum aldosterone, plasma renin activity (PRA), potassium and sodium levels, estimated glomerular filtration rate (eGFR), and the proportion of patients with eGFR reduction and symptomatic hypotension rate. Random-effects pairwise and network meta-analyses were performed. Results: Five RCTs comprising 2,639 patients across 29 countries were included. ASIs significantly reduced OSBP compared with placebo (mean difference [MD] –8.58 mmHg; 95% CI –9.91 to –7.25; I² = 0%). baxdrostat 2 mg achieved the greatest reduction in OSBP (MD –10.32 mmHg; 95% CI –13.50 to –7.14), ODBP (MD –4.27 mmHg), and ambulatory SBP (MD –17.00 mmHg). ASI therapy lowered serum aldosterone and increased PRA, confirming target engagement. Safety analysis showed ASIs were associated with reduced eGFR (MD –6.88 mL/min/1.73 m²), increased risks of hyperkalemia (RR 7.25), hyponatremia (RR 2.12), and symptomatic hypotension (RR 3.16). Dose-dependent risks were most pronounced with lorundrostat 100 mg. Conclusion: ASIs, particularly baxdrostat 2 mg, reduce blood pressure effectively in patients with uncontrolled hypertension, with consistent effects on aldosterone and renin. However, their use is limited by renal function decline, electrolyte disturbances, and increased adverse events at higher doses. Careful dose selection and monitoring are essential.
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