Ali, Karim

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 −8.72 to 0.29; p = 0.07) and SBP by 9.07 mmHg (95% CI −17.69 to −0.45; 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 −14.01 to −7.23; p < 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.

Objective: This meta-analysis aims to compare the effectiveness of intravascular ultrasound (IVUS) versus angiography alone in percutaneous coronary intervention (PCI) procedures. Methods: A comprehensive literature search was conducted to identify relevant studies comparing IVUS-guided PCI with angiography-guided PCI. The primary outcome measure was major adverse cardiac events (MACE) including cardiac death, myocardial infarction, and target vessel revascularization. Secondary outcomes included all-cause mortality, stent thrombosis, and angiographic outcomes. Results: A total of 41 eligible studies involving 712635 patients were included in the meta-analysis. IVUS-guided PCI was associated with a significantly lower risk of MACE compared to angiography-guided PCI (pooled odds ratio [OR] 1.38, 95% confidence interval [CI] 1.24-1.53, p<0.00001). The use of IVUS also resulted in a lower risk of all-cause mortality (pooled OR 1.61, 95% CI 1.41-1.83, p<0.00001) and reduced rates of stent thrombosis (pooled OR 2.28, 95% CI 1.82-2.86, p<0.00001) and TVR (pooled OR 1.31, 95% CI 1.21-1.42, p<0.00001). Conclusion: This meta-analysis provides evidence supporting the use of IVUS-guided PCI over angiography-guided PCI. IVUS-guided procedures were associated with reduced MACE rates, improved procedural success, decreased stent thrombosis, and superior angiographic outcomes. The findings suggest that incorporating IVUS into PCI procedures may lead to improved clinical outcomes and more optimal stent deployment. However, further studies are warranted to explore potential subgroup differences and to evaluate the cost-effectiveness of IVUS-guided PCI.