HypertensionMeta-analysis
Comparative Efficacy of Treatments for Resistant or Uncontrolled Hypertension
- systematic review and network meta-analysis of randomized trials
- random-effects network meta-analysis within a Bayesian framework
- certainty of evidence assessed using Confidence In Network Meta-Analysis (CINeMA)
Authors' conclusion
In head-to-head comparisons, no significant differences were observed between add-on treatments in reducing blood pressure among patients with resistant or uncontrolled hypertension. Treatment selection should prioritize treatments with demonstrated superiority over baseline treatment, including spironolactone, baxdrostat, and radiofrequency renal denervation.
Study context
- Population
- Patients with resistant or uncontrolled hypertension35 trials in the systematic review, 30 trials (8,187 patients) in the network meta-analysis · systematic review (35 trials) 8,648 · network meta-analysis (30 trials) 8,187
- Participants
- 8,648 patients
- Comparison
- Add-on treatments for resistant or uncontrolled hypertension compared with baseline treatment and head-to-head
- Outcome
- Change in office systolic blood pressure from baseline (patients with resistant hypertension)
Pooled result
As reported in the abstract
Mean difference, mm Hg (95% credible interval CI)
spironolactone vs baseline treatment
−12.43(−17.68 to −7.18)
radiofrequency renal denervation vs baseline treatment
−8.74(−12.96 to −4.52)
Further pooled results
Change in office systolic blood pressure in patients with uncontrolled hypertension
- Similar findings were observed in patients with uncontrolled hypertension
Head-to-head comparisons between interventions
- No intervention demonstrated clear superiority over another because most head-to-head comparisons included the possibility of no effect
Original publication
Comparative Efficacy of Treatments for Resistant or Uncontrolled Hypertension. JACC Adv. Published 5 October 2026. doi:10.1016/j.jacadv.2026.103306
Summarised from the published abstract; every number is checked against it