Mineralocorticoid receptor antagonist use in hypertensive populations was associated with lower all-cause mortality compared to control (10.7% vs 11.6%; OR 0.91; 95% CI 0.84-0.99).
Meta-Analysis (n=25,498)
Does mineralocorticoid receptor antagonist use reduce all-cause mortality in predominantly hypertensive populations?
In predominantly hypertensive populations, the use of mineralocorticoid receptor antagonists is associated with a significant reduction in all-cause mortality compared to placebo or usual care.
Effect estimate: OR 0.91 (95% CI 0.84-0.99)
Absolute Event Rate: 10.7% vs 11.6%
BACKGROUND: International guidelines differ in their recommendations for mineralocorticoid receptor antagonist (MRA) use in hypertension, as the effect on mortality is unclear. We meta-analyzed trial-level data to determine the association of MRA use with all-cause mortality in hypertension. METHODS: MEDLINE and EMBASE were searched for randomized clinical trials published from database inception through March 14, 2025, evaluating MRA use in trial populations with at least 85% prevalence of hypertension. The control groups consisted of placebo or usual care. Two reviewers independently screened and extracted data. Pooled estimates were calculated using random-effects and inverse variance models. The primary outcome was all-cause mortality. RESULTS: Seventeen randomized clinical trials were eligible for inclusion (n = 25 498), of which 12 trials reported mortality events (n = 24 426). The mean (±SD) baseline prevalence of hypertension was 95.0% (±5.0), mean baseline SBP was 134.8 (±9.0) mmHg, mean age was 64.1 (±5.3) years and 43.3% (n = 11 047) were female. The median duration of follow-up was 12 months (interquartile range 9-32 months). MRA use versus control was significantly associated with lower odds of all-cause mortality (12 trials, n = 24 426) (10.7 versus 11.6% over a median follow-up of 20.5 months; odds ratio (OR), 0.91 95% confidence interval, 95% CI, 0.84-0.99; absolute risk reduction, 0.88% 95% CI, 0.1-1.7; I2 = 0.0%). CONCLUSION: In this meta-analysis of randomized clinical trials in predominantly hypertensive populations with substantial comorbidity, MRA use was significantly associated with lower all-cause mortality. Further dedicated trials in hypertensive populations, with longer follow-up and mortality as primary outcome, are warranted to confirm these findings. (PROSPERO; CRD420250601811).
Teh et al. (Tue,) conducted a meta-analysis in Hypertension (n=25,498). Mineralocorticoid receptor antagonists vs. Placebo or usual care was evaluated on All-cause mortality (OR 0.91, 95% CI 0.84-0.99). Mineralocorticoid receptor antagonist use in hypertensive populations was associated with lower all-cause mortality compared to control (10.7% vs 11.6%; OR 0.91; 95% CI 0.84-0.99).