Ng, Khai P., Arnold, Julia, Sharif, Adnan, Gill, Paramjit, Townend, Jonathan N. and Ferro, Charles J. (2015) Cardiovascular actions of mineralocorticoid receptor antagonists in patients with chronic kidney disease : a systematic review and meta-analysis of randomized trials. Journal of the Renin-Angiotensin-Aldosterone System, 16 (3). pp. 599-613. doi:10.1177/1470320315575849 ISSN 1470-3203.

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Abstract

Introduction:
The safety and actions of mineralocorticoid receptor antagonists on surrogate markers of cardiovascular disease as well as major patient level cardiovascular end-points in patients with chronic kidney disease are unclear.

Methods:
MEDLINE, EMBASE, Trip Database, Cochrane Central Register of Controlled Trials, Cochrane Renal Group specialized register, Current Controlled Trials and clinicaltrials.gov were searched for relevant trials.

Results:
Twenty-nine trials (1581 patients) were included. Overall, mineralocorticoid receptor antagonists lowered both systolic and diastolic blood pressure (–5.24, 95% confidence interval (CI) –8.65, −1.82 mmHg; p=0.003 and −1.96, 95% CI −3.22, –0.69 mmHg; p=0.002 respectively). There were insufficient data to perform a meta-analysis of other cardiovascular effects. However, a systematic review of the studies included suggested a consistent improvement in surrogate markers of cardiovascular disease. Overall, the use of mineralocorticoid receptor antagonists was associated with an increased serum potassium (0.23, 95% CI 0.13, 0.33 mmol/l; p<0.0001) and higher risk ratio (1.76, 95% CI 1.20, 2.57; p=0.001) of hyperkalemia. Data on long-term cardiovascular outcomes and mortality were not available in any of the trials.

Conclusions:
The long-term effects of mineralocorticoid receptor antagonists on cardiovascular events, mortality and safety need to be established.

Item Type:	Journal Article
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title:	Journal of the Renin-Angiotensin-Aldosterone System
Publisher:	Sage Publications Ltd.
ISSN:	1470-3203
Official Date:	17 March 2015
Dates:	Date Event 17 March 2015 Published
Volume:	16
Number:	3
Page Range:	pp. 599-613
DOI:	10.1177/1470320315575849
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)

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