Efficacy and Safety of Aldosterone Synthase Inhibitors for Resistant Hypertension: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background: Compared to patients with controllable hypertension, those with resistant hypertension (RH) have a higher incidence of cardiovascular complications, including stroke, left ventricular hypertrophy, and congestive heart failure. Therefore, an urgent need exists for improved management and control, along with more effective medications. Aldosterone synthase inhibitors (ASIs) are newly emerging drugs that have gradually attracted an increasing amount of attention. Methods: The Cochrane Library, PubMed, Embase, and ClinicalTrials.gov databases were systematically searched to identify all literature on ASIs and resistant hypertension. Additionally, the reference lists of the included articles were manually searched. The quality of the identified studies was assessed using the Cochrane Bias Risk Tool. Results: This study comprised four randomized controlled trials (RCTs), involving 776 participants. Different doses of ASIs were used, with treatment durations ranging from 7 to 12 weeks. The selected study population included individuals with resistant hypertension and healthy adults. Systolic blood pressure (SBP) had a pooled effect size of standardized mean difference (SMD) = –0.24, with a 95% confidence interval (CI) of [–0.46, –0.03], indicating a statistically significant difference (p = 0.026); however, diastolic blood pressure (DBP) had a pooled effect size of SMD = –0.13, with a 95% CI of [–0.40, 0.15], indicating no significant difference (p = 0.359). Similarly, subgroup analyses yielded comparable results. Notably, the risk of adverse events in the ASI group was greater than that in the control group, with a risk ratio of 1.32 and a 95% CI of [1.04, 1.66], indicating a significant difference (p = 0.02). There was no statistically significant difference in severe adverse events between the treatment group and the control group (p = 0.532). Conclusions: ASIs have shown benefits in controlling SBP in patients with resistant hypertension, although their effects on DBP appear to be limited. Given the observation period of only 12 weeks, the potential for increased adverse event risks with their use warrants further attention. Considering the relatively small number of trials included and the limited sample size in this study, future research should focus on expanding the sample size and extending the follow-up duration to more precisely define the clinical role and value of ASIs. Additionally, further investigation into the underlying mechanisms of action of these inhibitors is necessary to provide theoretical support for optimizing treatment strategies for resistant hypertension and related conditions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.029 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.041 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".