Comparative Efficacy and Safety of Renal Denervation versus Spironolactone in the Management of Resistant Hypertension: A Systematic Review and Meta-Analysis

Introduction: Resistant hypertension is a critical condition and an important indicator for identifying patients at high risk of cardiovascular disease (CVD), yet selecting the optimal therapeutic approach remains a significant clinical challenge. Objective: This study aimed to assess and compare the efficacy and safety of renal denervation versus spironolactone in managing resistant hypertension. Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines. PubMed, ScienceDirect, and the Cochrane Library were searched for randomized controlled trials (RCTs) comparing renal denervation with spironolactone in resistant hypertension. Primary outcomes included reductions in office, daytime, nighttime, and 24-hour systolic blood pressure (SBP) and diastolic blood pressure (DBP). Safety outcomes focused on changes in serum creatinine and potassium levels. Pooled effect estimates were calculated using a random effects model and are presented as mean differences (MD). Results: Five RCTs with 361 participants (renal denervation:174, spironolactone:187) were analyzed. No significant differences were observed between renal denervation and spironolactone in reducing office SBP (MD:-0.31 mmHg, 95% CI[-6.81, 6.19],p=0.93,I2=71%) or DBP (MD:-1.74 mmHg,95% CI[-5, 1.51],p= 0.29,I2= 46%). Similar results were found for daytime, nighttime, and 24-hour BP. However, long-term spironolactone use significantly increased serum creatinine levels (MD:-4.80 μmol/L, 95% CI[-8.07, -1.52], p= 0.004, I2= 0%), with a non-significant trend toward elevated serum potassium (MD: -0.32 mmol/L, 95% CI[-0.80, 0.15], p= 0.18, I2= 94%). Conclusion: Renal denervation and spironolactone showed comparable efficacy in managing resistant hypertension. However, renal denervation may offer a safer long-term option due to fewer adverse effects.