Efficacy and safety of selective aldosterone synthase inhibitors for blood pressure reduction in patients with CKD: a meta-analysis of randomized controlled trials
In brief
Selective aldosterone synthase inhibitors cut systolic BP by roughly 8 mmHg in CKD patients
A meta-analysis of five randomized trials (1,148 participants) found that these drugs reduced systolic blood pressure by about 8 mmHg and lowered albuminuria by roughly one-third compared with placebo, while modestly decreasing diastolic pressure. Kidney function showed a small decline and hyperkalemia was more common, leaving safety and long-term renal impact uncertain.
- Journal
- Journal of hypertension (Q1)
- Published
- 24 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Marieta Theodorakopoulou, Fotini Iatridi, Aikaterini Theodosiadi, Manfred Hecking, Giovanni Strippoli, Pantelis Sarafidis
- PMID
- 42554270
- DOI
- 10.1097/HJH.0000000000004399
Why clinicians should know about it
- Picked for Internal Medicine (top studies of the week, 9 August 2026): Selective ASIs lower SBP by ~8 mmHg in CKD patients
- Picked for Nephrology (top studies of the week, 9 August 2026): Selective aldosterone synthase inhibitors lower BP and albuminuria in CKD
Abstract
Aldosterone synthase inhibitors (ASIs) demonstrated significant blood pressure (BP) lowering efficacy in patients with uncontrolled hypertension, but evidence in chronic kidney disease (CKD) remains limited. This meta-analysis explores the effects of selective ASIs on BP levels in CKD. Secondary outcomes were albuminuria (UACR), eGFR change and hyperkalemia incidence. Five RCTs (1,148 patients) were included; 2 used baxdrostat, 2 lorundrostat, and 1 study used vicadrostat. Treatment with ASIs was associated with a significant placebo-adjusted reduction in SBP of-7.9 mmHg [95% confidence interval (CI) -10.0 to -5.9, I2 = 0%] and DBP of -3.1 mmHg (95% CI -5.9 to -0.2, I2 = 62%) and reduced UACR by -31.7% (95% CI -54.5 to -8.9, I2 = 91%). The pooled placebo-adjusted eGFR change was -2.05 ml/min/1.73 m2 (95% CI -3.15 to -0.95, I2 = 0%). The risk of hyperkalemia was higher with ASIs, but with high heterogeneity (risk ratio, 4.04 [95% CI 0.94 to 17.35], I2 = 76%). In conclusion, selective ASIs present a potential treatment option for BP control and albuminuria reduction in patients with CKD.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.