Blood Pressure-Lowering Effects of Aldosterone Synthase Inhibitors-A Systematic Review

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#humans #hypertension #cytochrome-p-450-cyp11b2 #antihypertensive-agents #blood-pressure

Blood Pressure-Lowering Effects of Aldosterone Synthase Inhibitors-A Systematic Review

Rasmussen et al., 2025 | Basic Clin Pharmacol Toxicol | Systematic Review

Citation

Rasmussen Anders Almskou, Nordestgaard Ketil Lehm, ... Buus Niels Henrik. Blood Pressure-Lowering Effects of Aldosterone Synthase Inhibitors-A Systematic Review. Basic Clin Pharmacol Toxicol. 2025-Aug;137(2):e70080. doi:10.1111/bcpt.70080

Abstract

Excess aldosterone production contributes to the development of hypertension and results in fibrosis with dysfunction of the heart, vasculature and kidneys. Consequently, new agents have been developed to reduce endogenous aldosterone synthesis. The primary objective of this systematic review is to describe the BP-lowering effects of aldosterone synthase inhibitors (ASIs) in hypertensive patients and, secondly, to describe their potential renal protective effects and possible influence on cortisol production and plasma potassium. We searched PubMed, Embase and ClinicalTrials.gov and included randomized controlled and clinical trials according to PICO using the review tool Covidence. Thirteen studies were included and all demonstrated BP reduction through ASI treatment. Among patients with apparent resistant hypertension, the placebo-corrected reductions in seated systolic BP were 11.0 mmHg for baxdrostat and 9.6 mmHg for lorundrostat. A significant suppression of cortisol production was found for LCI699 (osilodrostat) but not for baxdrostat, lorundrostat, BI 690517 (vicadrostat) or dexfadrostat. Studies on BI 690517 showed a reduction in urine-albumin-creatinine ratio, indicating renal protection. ASIs may increase potassium levels. We conclude that ASIs have promising BP-lowering effects with very limited effects on cortisol production and offer reno-protective effects in chronic kidney disease. Studies on hypertensive target organ damage and cardiovascular outcomes are, however, lacking.

Key Findings

Studies on hypertensive target organ damage and cardiovascular outcomes are, however, lacking.

Outcomes Measured

  • systolic blood pressure
  • cortisol levels

Population

Field Value
Population apparent resistant hypertension
Sample Size See abstract
Age Range See abstract
Condition hypertension

MeSH Terms

  • Humans
  • Hypertension
  • Cytochrome P-450 CYP11B2
  • Antihypertensive Agents
  • Blood Pressure
  • Hydrocortisone
  • Potassium
  • Randomized Controlled Trials as Topic
  • Aldosterone
  • Enzyme Inhibitors
  • Kidney
  • Renal Insufficiency, Chronic

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Systematic Review, Journal Article
  • Vertical: potassium

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09