Synapse
⌘+K
Synapse
PulseExploreClubsResearchersJournals
Instagram
HomeClubsExplore
July 5, 2026Journal of Evidence-Based Medicine

MRAs reduce office SBP by ~9 mmHg vs control in resistant hypertension.

View Full Paper
Ask AI
Bookmark
Share

Why the study?

The comparative effect of different treatments on resistant hypertension was not comprehensively established.

Do different pharmacological, device-based, and lifestyle interventions reduce blood pressure in patients with resistant hypertension?

Population

Thirty-three eligible studies of patients with resistant hypertension

Comparison

Second-generation RDN, MRA, ERA, ASI, SGLT2i, BAT, central AV anastomosis, lifestyle, and control

Design

Systematic review and random-effects network meta-analysis

Key result

Mineralocorticoid receptor antagonists significantly lowered office systolic blood pressure compared to control (MD -9.11; 95% CI -10.44 to -7.79) in patients with resistant hypertension.

Authors

YXYao XiaoKFKun FengXCX P Chen

Discussion

Loading...

Member takes

Overview

Network meta-analysis ranks RH regimens by BP effect; leaves open optimal selection pending direct trials.

Key Points

  • The objective is to compare the efficacy of various treatment regimens for resistant hypertension using a network meta-analysis.
  • Conducted a systematic search in databases until April 1, 2026.
  • Performed a network meta-analysis using random effects to analyze treatment effects on systolic/diastolic blood pressure.
  • Included thirty-three eligible studies for the final analysis.
  • MRA significantly lowered office SBP by -9.11 (95% CI -10.44 to -7.79) compared to control.
  • RDN reduced office DBP by -6.63 (95% CI -8.58 to -4.68) compared to control.
  • Combining lifestyle changes with pharmacological therapies may provide optimal management for resistant hypertension.

Study Design

Type

Meta-Analysis

Structured PICO

Do different pharmacological, device-based, and lifestyle interventions reduce blood pressure in patients with resistant hypertension?

P
Population
Network meta-analysis of 33 studies comparing the efficacy of different pharmacological, device-based, and lifestyle treatments for resistant hypertension.
I
Intervention
Various treatments including 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, and lifestyle interventions
C
Comparator
Control group and active comparators (network meta-analysis)
O
Outcome
Change in office and 24-h systolic and diastolic blood pressure (SBP/DBP)surrogate

Main Result

Mean Difference: -9.11 (95% CI -10.44–-7.79)

In a network meta-analysis, MRA emerged as the most effective priority treatment for resistant hypertension, with aldosterone synthase inhibitors and renal denervation as optimal alternatives.

Limitations

  • More trials concerning other treatments for RH are needed.

Cite This Study

Xiao et al. (2026) conducted a meta-analysis in resistant hypertension (RH). Mineralocorticoid receptor antagonist (MRA) vs. Control group was evaluated on change of office systolic blood pressure (SBP) (MD -9.11, 95% CI -10.44 to -7.79). Mineralocorticoid receptor antagonists significantly lowered office systolic blood pressure compared to control (MD -9.11; 95% CI -10.44 to -7.79) in patients with resistant hypertension.

synapsesocial.com/papers/6a49f648f5d1d45b28800bf3https://doi.org/10.1111/jebm.70154
View Full Paper
Ask AI
Bookmark
Share