Aldosterone receptor antagonists significantly lowered office systolic blood pressure compared to control (MD -10.3; 95% CI -12.74 to -8) in patients with resistant hypertension.
Meta-Analysis
Do various pharmacological, device-based, and lifestyle interventions reduce blood pressure in patients with resistant hypertension?
In a network meta-analysis, MRAs and lifestyle modifications emerged as top treatments for resistant hypertension, with renal denervation serving as an effective alternative, particularly for uncontrolled diastolic blood pressure.
Mean Difference: -10.3 (95% CI -12.74–-8)
Objective: Our study tends to perform a network meta-analysis to compare the effect of different treatments on resistant hypertension (RH).Design and method: A systematic search was conducted in databases up to May 10, 2025. 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), aldosterone receptor antagonist (MRA), endothelin receptor antagonist, aldosterone synthase inhibitor, sodium-glucose cotransporter-2 inhibitors, baroreflex activation therapy, central arteriovenous anastomosis, lifestyle, and control group. Results: 26 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, -10.3, 95% confidence interval, -12.74 to -8 for office SBP; -4.36, -5.97 to -2.84 for office DBP; -9.73, -12.18 to -7.19 for 24-h SBP; -3.22, -5 to -1.44 for 24-h DBP). RDN effectively reduced both office and 24-h BP, and it caused a large reduction in DBP compared to control group (-6.09, -9.04 to -3.08 for office DBP; -3.34, -5.6 to -1.6 for 24-h DBP). Lifestyle modification effectively reduced office SBP and 24-h BP, and it as well as MRA were almost all in the top three treatments. Conclusions: MRA can be the priority treatment for RH. RDN is also a good alternative to MRA in the treatment of RH, especially in individuals characterized by uncontrolled DBP. A combination of lifestyle interventions alongside pharmacological/device-based therapies may represent the optimal approach. More trials concerning other treatments for RH are needed.
Xiao et al. (2026) conducted a meta-analysis in resistant hypertension. Aldosterone receptor antagonist (MRA) vs. Control group was evaluated on change of office systolic blood pressure (MD -10.3, 95% CI -12.74 to -8). Aldosterone receptor antagonists significantly lowered office systolic blood pressure compared to control (MD -10.3; 95% CI -12.74 to -8) in patients with resistant hypertension.