Evidence map›Paper›PMID 40901557›Full record

ReviewCardiac failure review2025

The Emerging Role of Aldosterone Synthase Inhibitors in Overcoming Renin-Angiotensin-Aldosterone System Therapy Limitations: A Narrative Review.

Shubh K Patel, Hwee Teoh, Ahreni Saunthar, Terrence M Yau, Subodh Verma

Abstract readReview
In one paragraph

Review in Cardiac failure review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–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

6 citing papers in PubMed.

  1. Review
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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

5 authors.

Shubh K PatelTemerty Faculty of Medicine, University of Toronto, Toronto Ontario, Canada.ORCID https://orcid.org/0000-0002-3435-8487
Hwee TeohDivision of Cardiac Surgery, St Michael's Hospital of Unity Health Toronto, Toronto Ontario, Canada.ORCID https://orcid.org/0000-0003-1036-4767
Ahreni SauntharMarlee Medical Centre, Toronto Ontario, Canada.ORCID https://orcid.org/0009-0006-2083-7344
Terrence M YauTemerty Faculty of Medicine, University of Toronto, Toronto Ontario, Canada.ORCID https://orcid.org/0009-0005-0881-3115
Subodh VermaTemerty Faculty of Medicine, University of Toronto, Toronto Ontario, Canada.ORCID https://orcid.org/0000-0002-4018-8533

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The renin-angiotensin-aldosterone system is integral to cardiorenal health, with aldosterone controlling fluid balance, blood pressure and cardiac remodelling. Despite the widespread use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and mineralocorticoid receptor antagonists, 'aldosterone escape' persists, contributing to treatment failure and adverse outcomes. Steroidal mineralocorticoid receptor antagonists also cause hyperkalaemia and anti-androgenic effects, limiting their use. Aldosterone synthase inhibitors (ASIs) selectively block cytochrome P450 11B2, reducing pathological aldosterone levels while preserving basal mineralocorticoid receptor activity, thus potentially lowering hyperkalaemia risk. This narrative review identified 41 relevant publications from a PubMed/MEDLINE search of "aldosterone synthase inhibitor" through 11 January 2025. Early clinical trials of ASIs (baxdrostat, lorundrostat, vicadrostat, dexfadrostat phosphate, JX09) report significant reductions in aldosterone, blood pressure and albuminuria, with promising safety. Challenges include ensuring high selectivity, mitigating hyperkalaemia and establishing long-term benefits. Ongoing Phase III trials will clarify their efficacy, safety and synergy with additional therapies - including sodium-glucose cotransporter 2 inhibitors - and clinical outcomes, positioning ASIs as an important advance in renin-angiotensin-aldosterone system modulation.

Indexed as

aldosteroneAldosterone synthase inhibitorshypertensionmineralocorticoid receptorrenin–angiotensin–aldosterone system

Identifiers

PMID40901557
PMCPMC12400170

What Socratic holds

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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.