Efficacy and safety outcomes of aldosterone synthase inhibitors for resistant hypertension: A meta-analysis of randomized controlled trials

Introduction Aldosterone synthase inhibitors (ASIs) have emerged as a promising therapeutic approach for blood pressure (BP) management. Materials and Methods We searched the PubMed, Web of Science, EMBASE and Cochrane Library databases until July 11, 2025. We expressed continuous outcome data as mean differences (MDs) with 95% confidence intervals (CIs) and dichotomous outcome data as risk ratios (RRs) with 95% CIs. Results Five randomized controlled trials involving 1958 patients (mean age, 60 years; 54% men) were included. The pooled results showed that ASIs significantly reduced SBP compared with placebo, with a mean difference of −7.08 mmHg (95% CI: −9.24 to −4.93). There was no significant difference between patients assigned to ASIs treatment and placebo on serious adverse events (RR,1.16; 95% CI,0.47–2.88). Additionally, significant reductions were observed among patients receiving ASIs treatment compared with receiving placebo on the change in diastolic blood pressure (DBP), with a mean difference of −2.96 mmHg (95% CI: −4.6 to −1.32). Conclusions ASIs effectively reduce SBP and DBP in patients with resistant hypertension (RHT) and demonstrate a generally favorable safety profile, although the increased risk of hyperkalemia and other adverse events warrants consideration. These results support the potential of ASIs as a therapeutic option for RHT, requiring confirmation in larger-scale studies.