{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T01:06:11Z","timestamp":1785546371792,"version":"3.56.0"},"reference-count":32,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Esaxerenone, a novel non-steroidal mineralocorticoid receptor antagonist, has shown promising results in the treatment of essential hypertension (HTN). This study aims to comprehensively analyze the effectiveness of esaxerenone to control BP in patients with essential HTN. Methods: A systematic search was performed on PubMed, Scopus, Web of Science (WOS), and Cochrane Library from inception until January 2025 for randomized controlled trials (RCTs) comparing esaxerenone with standard HTN usual care. The primary outcome of interest was mean changes in sitting systolic (SBP) and diastolic blood pressure (DBP). Other secondary outcomes were mean changes in 24 h-SBP and 24 h-DBP, and target BP achievement. Safety outcomes, such as adverse events and increased levels of potassium\/uric acid, were also assessed. Results: Our meta-analysis included four studies with a total of 1981 patients, all conducted in Japan. Esaxerenone demonstrated dose-dependent blood pressure reductions. At 5 mg, sitting DBP decreased by 4.22 mmHg (95% CI \u22128.72 to 0.29; p = 0.07) and SBP by 9.07 mmHg (95% CI \u221217.69 to \u22120.45; p = 0.04), while the 1.25 mg dose showed smaller, non-significant reductions. For 24 h measurements, only the 5 mg dose achieved significant reductions. Target BP achievement increased by 48% overall (RR 1.48, 95% CI 1.11 to 1.96; p = 0.007), with stronger effects at 5 mg (RR 2.05, 95% CI 1.03 to 4.08; p = 0.04). Esaxerenone significantly reduced nocturnal SBP by 10.62 mmHg (95% CI \u221214.01 to \u22127.23; p &lt; 0.001). Conclusions: In patients with essential HTN, esaxerenone was shown to be safe and well-tolerated compared with usual care. Long-term data on safety is warranted.<\/jats:p>","DOI":"10.3390\/jcm14165663","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T09:59:13Z","timestamp":1754906353000},"page":"5663","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Efficacy and Safety of Esaxerenone for Essential Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1972-3885","authenticated-orcid":false,"given":"Abdelrahman","family":"Hafez","sequence":"first","affiliation":[{"name":"Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA 02474, USA"},{"name":"Cardiovascular Medicine Department, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1257-3450","authenticated-orcid":false,"given":"Ahmed","family":"Abdelaziz","sequence":"additional","affiliation":[{"name":"Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA 02474, USA"},{"name":"Division of Cardiology, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NY 10461, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8938-5723","authenticated-orcid":false,"given":"Ahmed","family":"Mansour","sequence":"additional","affiliation":[{"name":"Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA 02474, USA"},{"name":"Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Kamal","sequence":"additional","affiliation":[{"name":"Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA 02474, USA"},{"name":"Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4470-0012","authenticated-orcid":false,"given":"Ali","family":"Bakr","sequence":"additional","affiliation":[{"name":"Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA 02474, USA"},{"name":"Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5802-2291","authenticated-orcid":false,"given":"Ahmed Farid","family":"Gadelmawla","sequence":"additional","affiliation":[{"name":"Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA 02474, USA"},{"name":"Faculty of Medicine, Menoufia University, Menoufia 32511, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7886-7435","authenticated-orcid":false,"given":"Hanaa","family":"Elsayed","sequence":"additional","affiliation":[{"name":"Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA 02474, USA"},{"name":"Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Reyad","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Cardiology Department, Banner University Medical Center, Phoenix, AZ 85006, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4318-8843","authenticated-orcid":false,"given":"Karim","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Elhelw","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Kentucky Healthcare, University of Kentucky, KY 40536, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2194","DOI":"10.1097\/HJH.0b013e32833eafa3","article-title":"Treatment of resistant hypertension","volume":"28","author":"Pimenta","year":"2010","journal-title":"J. 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