Journal of evidence-based medicine · 2026
Comparison of the Efficacy of Different Treatment Regimens for Resistant Hypertension: A Systematic Review and Network Meta-Analysis.
СтатьяСистематический обзорNetwork Meta-AnalysisСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Xiao Yao, Feng Kun, Chen Xiaoping, Peng Yong, Liu Kai
Аннотация
PURPOSE: Our study tends to perform a network meta-analysis to compare the effect of different treatments on resistant hypertension (RH).
METHODS: A systematic search was conducted in databases up to April 1, 2026. We conducted a network meta-analysis using random effects to compare the change of systolic/diastolic blood pressure (SBP/DBP) between the following interventions: second-generation renal denervation (RDN), mineralocorticoid receptor antagonist (MRA), endothelin receptor antagonist, aldosterone synthase inhibitor (ASI), sodium-glucose cotransporter-2 inhibitors, baroreflex activation therapy, central arteriovenous anastomosis, lifestyle, and control group.
RESULTS: Thirty-three eligible studies were included in the final analysis. After conducting sensitivity analyses, MRA significantly lowered both office and 24-h blood pressure (BP) compared to control group (mean difference -9.11, [95% confidence interval -10.44 to -7.79] for office SBP; -4.97 [-5.83 to -4.11] for office DBP; -9.64 [-11.73 to -7.54] for 24-h SBP; -3.75 [-5.08 to -2.42] for 24-h DBP). RDN effectively reduced both office and 24-h BP, and it caused a large reduction in office DBP compared to control group (-6.63 [-8.58 to -4.68] for office DBP; -3.36 [-4.57 to -2.14] for 24-h DBP). Lifestyle and ASI effectively reduced office and 24-h BP, and it as well as MRA were almost in the top three treatments.
CONCLUSION: MRA can be the priority treatment for RH. ASI and RDN are also optimal alternatives to MRA, particularly suitable for 24-h BP and uncontrolled DBP management, respectively. A combination of lifestyle alongside pharmacological/device-based therapies may represent the optimal approach. More trials concerning other treatments for RH are needed.
METHODS: A systematic search was conducted in databases up to April 1, 2026. We conducted a network meta-analysis using random effects to compare the change of systolic/diastolic blood pressure (SBP/DBP) between the following interventions: second-generation renal denervation (RDN), mineralocorticoid receptor antagonist (MRA), endothelin receptor antagonist, aldosterone synthase inhibitor (ASI), sodium-glucose cotransporter-2 inhibitors, baroreflex activation therapy, central arteriovenous anastomosis, lifestyle, and control group.
RESULTS: Thirty-three eligible studies were included in the final analysis. After conducting sensitivity analyses, MRA significantly lowered both office and 24-h blood pressure (BP) compared to control group (mean difference -9.11, [95% confidence interval -10.44 to -7.79] for office SBP; -4.97 [-5.83 to -4.11] for office DBP; -9.64 [-11.73 to -7.54] for 24-h SBP; -3.75 [-5.08 to -2.42] for 24-h DBP). RDN effectively reduced both office and 24-h BP, and it caused a large reduction in office DBP compared to control group (-6.63 [-8.58 to -4.68] for office DBP; -3.36 [-4.57 to -2.14] for 24-h DBP). Lifestyle and ASI effectively reduced office and 24-h BP, and it as well as MRA were almost in the top three treatments.
CONCLUSION: MRA can be the priority treatment for RH. ASI and RDN are also optimal alternatives to MRA, particularly suitable for 24-h BP and uncontrolled DBP management, respectively. A combination of lifestyle alongside pharmacological/device-based therapies may represent the optimal approach. More trials concerning other treatments for RH are needed.