Decoding the efficacy and safety profiles of anti-hypertensive agents by targeting RAAS: A systematic review and meta-analysis of clinical trials
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Starry Homenta Rampengan 1 , Derren David Christian Homenta Rampengan 2 , Roy Novri Ramadhan 3 4 , Sebastian Emmanuel Willyanto 5 , Josh Nathaniel Jowono 6 , Kevin Christian Tjandra 4 7 , Laksmana Adi Krista Nugraha 7 , Merita Arini 4 *
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1 Department of Cardiovascular Medicine, Faculty of Medicine, Universitas Sam Ratulangi, Manado, INDONESIA2 Faculty of Medicine, Universitas Sam Ratulangi, Manado, INDONESIA3 Faculty of Medicine, Universitas Airlangga, Surabaya, INDONESIA4 Master of Hospital Administration, Postgraduate Program, Universitas Muhammadiyah Yogyakarta, Yogyakarta, INDONESIA5 Faculty of Medicine, Universitas Brawijaya, Malang, INDONESIA6 Faculty of Medicine, Universitas Indonesia, Jakarta, INDONESIA7 Department of Medicine, Faculty of Medicine, Universitas Diponegoro, Semarang, INDONESIA* Corresponding Author

Abstract

Introduction: This study reviews the efficacy and safety of angiotensin receptor neprilysin inhibitor (ARNI), nonsteroidal mineralocorticoid receptor antagonists (NMRA), brain rennin-angiotensin system (RAS) therapy, and ribonucleic acid (RNA)-based therapy with evaluating systolic blood pressure and diastolic blood pressure control as well safety by counting adverse events.
Methods: Risk of Bias 2.0 were used for quality appraisal and RevMan 5.4 was applied for the meta-analysis.
Results: From five databases, 20 articles were selected for review. Six high-risk and fourteen low-risk studies. ARNI and RNA-based therapies improved BP regulation, while NMRA and brain RAS were less effective in managing high blood pressure. In terms of safety, NMRA and RNA-based therapies had fewer adverse events, whereas ARNI and brain RAS had more AEs compared to their control groups.
Conclusion: RNA-based therapy outperforms the four antihypertensive drugs studied in terms of efficacy and safety, underscoring its potential as the leading option and justifying further research.

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article Type: Review Article

ELECTRON J GEN MED, Volume 22, Issue 3, June 2025, Article No: em645

https://doi.org/10.29333/ejgm/16227

Publication date: 01 May 2025

Online publication date: 01 Apr 2025

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Article Downloads: 45

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