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July 5, 2026Journal of Evidence-Based Medicine

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

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Why the study?

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

Population

Patients with resistant hypertension (33 eligible studies included)

Comparison

Various treatments including second-generation… vs Control group and active comparators

Design

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

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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
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