Aldosterone synthase inhibitors in the treatment of resistant hypertension: a systematic review

Abstract

Objective: To compile results from randomized clinical trials that evaluate the effects of aldosterone synthase inhibitors on systolic and diastolic blood pressures in patients with resistant hypertension. Methods: A systematic review of studies available in the PubMed/MEDLINE, Embase, and The Cochrane Library databases was conducted. Randomized clinical trials published in any year were included, and studies involving populations with a history of secondary hypertension of any etiology, poorly controlled diabetes, and a glomerular filtration rate < 45 ml/min/1.73 m² were excluded. The risk of bias of the trials was assessed using the RoB 2 tool, and the protocol of this review was registered in PROSPERO (CRD420251170276). Results: The final sample included four studies. LCI699 showed modest changes in systolic and diastolic blood pressures. Baxdrostat and lorundrostat demonstrated consistent reductions in systolic blood pressure. Final considerations: Baxdrostat and lorundrostat represent a promising therapeutic strategy for the treatment of resistant hypertension. However, the available evidence is still limited by the small number of clinical trials, methodological heterogeneity, and the absence of higher-impact clinical outcomes, indicating the need for further studies.