Blood Pressure-Lowering Effects of Finerenone: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
6 affiliations
- 1Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, ASL Roma 1, 00135 Rome, Italy
- 2Independent Researcher, 00189 Rome, Italy
- 3Interventional Cardiology, Sandro Pertini Hospital, 00157 Rome, Italy
- 4Division of Cardiology, Santo Spirito Hospital, 15033 Alessandria, Italy
- 5Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, S. Camillo-Forlanini Hospital, 00152 Rome, Italy
- 6Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
Abstract
Background: Optimal blood pressure (BP) control remains elusive for millions of patients worldwide, often leading to resistant or secondary hypertension. Overactivation of the mineralocorticoid receptor (MR) drives this systemic pathology. While steroidal mineralocorticoid receptor antagonists (MRAs) are effective, their clinical utility is limited by poor cross-selectivity and risk of hyperkalemia. Finerenone, a novel non-steroidal MRA, offers high selectivity and potent target-organ protection, but a comprehensive pooling of its direct impact on BP is still needed. Methods: Following the PRISMA guidelines, a systematic search was conducted across PubMed, Embase, and ClinicalTrials.gov up to August 2026 for randomized controlled trials (RCTs) comparing finerenone versus placebo and reporting BP outcomes. The primary outcome was office systolic blood pressure (SBP). Results: Six RCTs involving 19,609 patients were included. Finerenone demonstrated a statistically significant but modest reduction in both office SBP (LSM difference: −2.83 mmHg; 95% CI: −3.15 to −2.51; p < 0.001) and office diastolic blood pressure (DBP) (LSM difference: −1.04 mmHg; 95% CI: −1.37 to −0.70; p < 0.001) compared with the placebo, with an absence of statistical heterogeneity (I2 = 0.00%). Subgroup analysis confirmed office SBP-lowering efficacy across different clinical phenotypes, including chronic kidney disease and heart failure (p for interaction = 0.18). In a small subset of patients, finerenone reduced 24-h ambulatory SBP (LSM difference: −7.88 mmHg; 95% CI: −10.94 to −4.82; p < 0.001), though these exploratory findings warrant caution due to the limited sample size; no significant reduction was observed for 24-h ambulatory DBP. Conclusions: Finerenone is associated with a modest but statistically significant reduction in systemic SBP.
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BibTeX
@article{marino2026blood,
title = {{Blood Pressure-Lowering Effects of Finerenone: A Systematic Review and Meta-Analysis of Randomized Controlled Trials}},
author = {Gaetano Marino and Stefania Angela Di Fusco and Elvira Graziano and Sara Corradetti and Stefano Aquilani and Silvio Fedele and Federico Nardi and Domenico Gabrielli and Carmine Savoia and Furio Colivicchi},
journal = {Journal of clinical medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15197694},
url = {https://europepmc.org/article/PMC/PMC13665816},
note = {CC BY},
}
RIS
TY - JOUR
TI - Blood Pressure-Lowering Effects of Finerenone: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
AU - Gaetano Marino
AU - Stefania Angela Di Fusco
AU - Elvira Graziano
AU - Sara Corradetti
AU - Stefano Aquilani
AU - Silvio Fedele
AU - Federico Nardi
AU - Domenico Gabrielli
AU - Carmine Savoia
AU - Furio Colivicchi
PY - 2026
DA - 2026/10/01
JO - Journal of clinical medicine
DO - 10.3390/jcm15197694
UR - https://europepmc.org/article/PMC/PMC13665816
AB - Background: Optimal blood pressure (BP) control remains elusive for millions of patients worldwide, often leading to resistant or secondary hypertension. Overactivation of the mineralocorticoid receptor (MR) drives this systemic pathology. While steroidal mineralocorticoid receptor antagonists (MRAs) are effective, their clinical utility is limited by poor cross-selectivity and risk of hyperkalemia. Finerenone, a novel non-steroidal MRA, offers high selectivity and potent target-organ protection, but a comprehensive pooling of its direct impact on BP is still needed. Methods: Following the PRISMA guidelines, a systematic search was conducted across PubMed, Embase, and ClinicalTrials.gov up to August 2026 for randomized controlled trials (RCTs) comparing finerenone versus placebo and reporting BP outcomes. The primary outcome was office systolic blood pressure (SBP). Results: Six RCTs involving 19,609 patients were included. Finerenone demonstrated a statistically significant but modest reduction in both office SBP (LSM difference: −2.83 mmHg; 95% CI: −3.15 to −2.51; p < 0.001) and office diastolic blood pressure (DBP) (LSM difference: −1.04 mmHg; 95% CI: −1.37 to −0.70; p < 0.001) compared with the placebo, with an absence of statistical heterogeneity (I2 = 0.00%). Subgroup analysis confirmed office SBP-lowering efficacy across different clinical phenotypes, including chronic kidney disease and heart failure (p for interaction = 0.18). In a small subset of patients, finerenone reduced 24-h ambulatory SBP (LSM difference: −7.88 mmHg; 95% CI: −10.94 to −4.82; p < 0.001), though these exploratory findings warrant caution due to the limited sample size; no significant reduction was observed for 24-h ambulatory DBP. Conclusions: Finerenone is associated with a modest but statistically significant reduction in systemic SBP.
SN - 2077-0383
ER -