https://journals.lww.com/jhypertension/fulltext/9900/mineralocorticoid_receptor_antagonists_and.894.aspxMineralocorticoid receptor antagonist (MRA) therapy was associated with lower all-cause mortality in predominantly hypertensive populations in a meta-analysis of randomized clinical trials published in the Journal of Hypertension.

The analysis included randomized clinical trials identified through MEDLINE and EMBASE searches from database inception through March 14, 2025. Eligible studies evaluated MRA therapy in populations with at least 85% prevalence of hypertension and compared MRAs with placebo or usual care. The primary outcome was all-cause mortality.

Seventeen randomized clinical trials involving 25,498 participants met inclusion criteria, while 12 trials reporting mortality outcomes included 24,426 participants. Across studies, the mean baseline prevalence of hypertension was 95.0%, the mean systolic blood pressure was 134.8 mmHg, the mean age was 64.1 years, and 43.3% of participants were female. Median follow-up duration was 12 months.

Compared with placebo or usual care, MRA therapy was associated with significantly lower odds of all-cause mortality. Mortality occurred in 10.7% of patients receiving MRAs versus 11.6% of controls over a median follow-up of 20.5 months. The pooled odds ratio (OR) for all-cause mortality was 0.91 (95% confidence interval [CI] 0.84-0.99), corresponding to an absolute risk reduction of 0.88% (95% CI 0.1-1.7). No significant statistical heterogeneity was observed across studies (I² = 0.0%).

The findings suggest that MRA therapy may be associated with reduced all-cause mortality in predominantly hypertensive populations. The analysis also highlighted the need for dedicated long-term trials evaluating mortality outcomes in hypertensive populations.