醛固酮合成酶抑制剂治疗高血压的疗效和安全性：系统综述和荟萃分析

IF 2.6 Q3 ENDOCRINOLOGY & METABOLISM

Endocrinology, Diabetes and Metabolism Pub Date : 2025-09-12 DOI:10.1002/edm2.70094

Jia Shen Goh, Sameen Sohail, Haroon Ayub, Zian Zafar Cheema, Nitish Behary Paray, Sanka Adikari, Ahmad Mesmar, Mohammad Atout, Abdul Rehman Qazi, Ahmad Aldalqamouni, Bilal Younas, Muhammad Atif Rauf, Muhammad Azhar Waheed Khan, Aya Abouayana, Ahmed Eid Ahmed Abouayana, Ali Hasan, Maryam Shahzad, Mushood Ahmed, Raheel Ahmed, Saeed Ahmed

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引用次数: 0

摘要

背景：高血压仍然是全球心血管发病率和死亡率的主要原因。醛固酮是调节血压的关键激素，在高血压病理生理中起着重要作用。这使得人们对醛固酮合成酶抑制剂（ASIs）作为一种潜在的治疗方法越来越感兴趣。本荟萃分析旨在评估ASIs治疗高血压的有效性和安全性。方法系统检索PubMed、b谷歌Scholar和Cochrane Central，检索截至2025年7月13日的随机对照试验（RCTs），以评估成人高血压患者的ASIs。数据分析使用RevMan version 5.4，采用随机效应模型，显著性设置为p <； 0.05。结果共纳入8项随机对照试验，ASI组共2003名受试者，安慰剂组650名受试者。与安慰剂相比，ASIs显著降低收缩压（SBP）（MD: - 6.01 mmHg； 95%可信区间[CI]: - 9.31至- 2.71;I2 = 85%; p = 0.0004）；发现两组舒张压（DBP）具有可比性（MD: - 2.20 mmHg; 95% CI: - 4.46 ~ 0.06; I2 = 69%; p = 0.06）。血清醛固酮水平显著降低，有利于使用ASI （MD: - 1.46; 95% CI: - 2.76至- 0.16;I2 = 99%; p < 0.00001）。严重不良事件（RD: 0.00; 95% CI:−0.01 ~ 0.02;I2 = 30%; p = 0.75）和非严重不良事件（RD: 0.05; 95% CI:−0.02 ~ 0.12;I2 = 64%; p = 0.20）的风险在ASI组和安慰剂组之间无显著差异。然而，ASI的使用与高钾血症的风险显著增高相关（RD: 0.04; 95% CI: 0.02 ~ 0.06; I2 = 70%; p = 0.002）。结论ASIs能有效降低成人高血压患者的收缩压和血清醛固酮。总的来说，它们似乎是安全的，但可能会增加高钾血症的风险。

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Efficacy and Safety of Aldosterone Synthase Inhibitors in Hypertension: A Systematic Review and Meta-Analysis

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Efficacy and Safety of Aldosterone Synthase Inhibitors in Hypertension: A Systematic Review and Meta-Analysis

Background

Hypertension remains a major contributor to global cardiovascular morbidity and mortality. Aldosterone, a key hormone in blood pressure regulation, plays a significant role in hypertension pathophysiology. This has led to growing interest in aldosterone synthase inhibitors (ASIs) as a potential treatment. This meta-analysis aims to evaluate the efficacy and safety of ASIs in managing hypertension.

Methods

A systematic search of PubMed, Google Scholar and Cochrane Central was conducted up to 13 July 2025, to identify randomised controlled trials (RCTs) evaluating ASIs in hypertensive adults. Data were analysed using RevMan version 5.4, employing random-effects models with significance set at p < 0.05.

Results

A total of 8 RCTs were included, with a total of 2003 participants in the ASI group and 650 participants in the placebo group. ASIs significantly reduced systolic blood pressure (SBP) compared to placebo (MD: −6.01 mmHg; 95% confidence interval [CI]: −9.31 to −2.71; I² = 85%; p = 0.0004); diastolic blood pressure (DBP) was found to be comparable between the two groups (MD: −2.20 mmHg; 95% CI: −4.46 to 0.06; I² = 69%; p = 0.06). There was a significant reduction in serum aldosterone levels favouring ASI use (MD: −1.46; 95% CI: −2.76 to −0.16; I² = 99%; p < 0.00001). The risk of serious (RD: 0.00; 95% CI: −0.01 to 0.02; I² = 30%; p = 0.75) and non-serious adverse events (RD: 0.05; 95% CI: −0.02 to 0.12; I² = 64%; p = 0.20) did not differ significantly between ASI and placebo groups. However, ASI use was associated with a significantly higher risk of hyperkalemia (RD: 0.04; 95% CI: 0.02 to 0.06; I² = 70%; p = 0.002).