Evidence map›Paper›PMID 39557029›Full record

ReviewKidney & blood pressure research2024

Aldosterone Synthase Inhibitors for Cardiorenal Protection: Ready for Prime Time?

Alessio Mazzieri, Francesca Timio, Francesco Patera, Francesco Trepiccione, Mario Bonomini, Gianpaolo Reboldi

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Kidney & blood pressure research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Efficacy and Safety of Lorundrostat in Uncontrolled and/or Treatment Resistant Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Alessio MazzieriDiabetes Clinic, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
Francesca TimioDivision of Nephrology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
Francesco PateraDivision of Nephrology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
Francesco TrepiccioneDepartment of Medical Translational Sciences, University of Campania, Naples, Italy.
Mario BonominiNephrology and Dialysis Unit, Department of Medicine, G. D'Annunzio University, Chieti, Italy.
Gianpaolo ReboldiDivision of Nephrology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAldosterone is the principal mineralocorticoid hormone and the final effector of the renin-angiotensin-aldosterone system. This hormone is primarily synthesized by the CYP11B2 enzyme and produced by the adrenal zona glomerulosa. Through genomic and non-genomic effects, it plays an important role in cardiovascular and renal disease. To counteract aldosterone-mediated damage, steroidal mineralocorticoid receptor antagonists are recommended by international guidelines, but endocrine side effects often limit their use in a substantial proportion of patients. Conversely, nonsteroidal mineralocorticoid receptor antagonists, with an improved selectivity and safety profile, are gaining a prominent position among therapeutic pillars. However, blocking the mineralocorticoid receptors does not completely inhibit aldosterone effects because of escape mechanisms and non-genomic activity. Thus, inhibiting aldosterone synthesis could be a promising strategy to prevent aldosterone-mediated cardiorenal damage. The limited specificity for CYP11B2 and side effects due to off-target activity hampered the development of first-generation aldosterone synthase inhibitors (ASIs). SUMMARY: The development of highly specific ASIs led to successful clinical trials in patients with resistant and uncontrolled hypertension. Additionally, a recent randomized clinical trial showed a significant benefit of ASIs in patients with chronic kidney disease and albuminuria. KEY MESSAGES: The strength of the clinical evidence collected so far is still limited, and larger outcome-based clinical trials are needed to confirm the promising role of ASIs in cardiorenal damage.

Indexed as

Cytochrome P-450 CYP11B2Enzyme InhibitorsRenal Insufficiency, ChronicAldosteroneAnimalsHumansMineralocorticoid Receptor AntagonistsAldosteroneCytochrome P-450 CYP11B2Enzyme InhibitorsMineralocorticoid Receptor AntagonistsAldosteroneAldosterone synthase inhibitorsChronic kidney diseaseHypertensionMineralocorticoid receptorMineralocorticoid receptor antagonists

Identifiers

PMID39557029
PMCPMC11844674

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.