{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T21:20:10Z","timestamp":1793654410014,"version":"4.5.1"},"reference-count":87,"publisher":"American Medical Association (AMA)","issue":"16","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,4,28]]},"abstract":"\n Importance<\/jats:title>\n Hypertension, defined as office systolic blood pressure (SBP) 130 mm Hg or greater and\/or diastolic blood pressure 80 mm Hg or greater, affects 43.9% of women and 49.5% of men in the US. Approximately 19.7% of patients treated for hypertension have apparent resistant hypertension (blood pressure \u2265130\/80 mm Hg) despite using 3 or more antihypertensive medications, preferably a renin-angiotensin system blocker, a calcium channel blocker, and a thiazide-type diuretic, at maximally tolerated doses.<\/jats:p>\n <\/jats:sec>\n \n Observations<\/jats:title>\n \n Approximately 10% of patients treated for hypertension have true resistant hypertension confirmed with home or 24-hour ambulatory blood pressure monitoring to exclude white-coat hypertension (approximately 37.5% of apparent resistant hypertension) and after excluding medication nonadherence (approximately 50%) and secondary hypertension such as primary aldosteronism (approximately 5%-25%). Conditions associated with resistant hypertension include obesity, diabetes, chronic kidney disease, and sleep apnea. Resistant hypertension is associated with increased risk of cardiovascular death vs controlled blood pressure at 5 years to 10 years (absolute risk increase, 10.3% [95% CI, 8.7%-12.1%]). Lifestyle modifications for resistant hypertension include a low-sodium diet (&amp;lt;1500 mg\/d), reducing or avoiding alcohol, 150 min\/wk or more of aerobic exercise, and weight loss. Illicit drugs (eg, cocaine) and medications that increase blood pressure (eg, nonsteroid anti-inflammatory drugs, serotonin-norepinephrine reuptake inhibitors) should be avoided. Sleep apnea should be treated when diagnosis is confirmed. Pharmacologic optimization includes use of combination tablets of antihypertensives; intensifying diuretic therapy by using chlorthalidone; and sequential addition of antihypertensive medications using evidence-based algorithms. In a meta-analysis of 20 studies (9 randomized clinical trials [RCTs] and 11 observational studies [331 participants]), use of antihypertensive therapies that combine 2 to 3 medications into a single formulation reduced SBP by \u22123.99 mm Hg (95% CI, \u22127.92 to \u22120.07) vs equivalent doses given separately. For patients with apparent or true resistant hypertension who have an estimated glomerular filtration rate of 45 mL\/min\/1.73 m\n 2<\/jats:sup>\n or greater and a serum potassium level of 4.5 mmol\/L or less, adding spironolactone (25-50 mg\/d) compared with placebo lowers office SBP by \u221213.3 mm Hg (95% CI, \u221217.89 to \u22128.72 [4 RCTs]) and 24-hour ambulatory SBP by \u22128.46 mm Hg (95% CI, \u221212.54 to \u22124.38 [2 RCTs]) in a network meta-analysis of 24 RCTs (3485 patients with resistant hypertension). A meta-analysis of 10 RCTs (2478 participants) reported that compared with a sham procedure, catheter-based renal denervation, which disrupts the sympathetic nerves in the renal artery walls, decreased 24-hour ambulatory SBP by \u22124.4 mm Hg (95% CI, \u22126.1 to \u22122.7) and office SBP by \u22126.6 mm Hg (95% CI, \u22129.7 to \u22123.6).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n True resistant hypertension affects 10% of patients treated for hypertension and is diagnosed after excluding white-coat hypertension, medication nonadherence, and secondary hypertension such as primary aldosteronism. First-line treatment includes lifestyle modifications, diuretic therapy with chlorthalidone, and combination tablets of antihypertensives. Spironolactone and renal denervation decrease blood pressure in patients with true resistant hypertension.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.1221","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T15:30:33Z","timestamp":1774279833000},"page":"1428","source":"Crossref","is-referenced-by-count":17,"title":["Diagnosis and Management of Resistant Hypertension"],"prefix":"10.1001","volume":"335","author":[{"given":"Michel","family":"Azizi","sequence":"first","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, INSERM CIC1418, APHP, Department of Hypertension, H\u00f4pital Europ\u00e9en Georges Pompidou, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanpen","family":"Vongpatanasin","sequence":"additional","affiliation":[{"name":"Hypertension Section, Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi D. L.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Hypertension, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Mahfoud","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Heart Center, University Hospital Basel, Switzerland"},{"name":"Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Amar","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, Department of Hypertension and Adrenal Referral Center, APHP, H\u00f4pital Europ\u00e9en Georges Pompidou, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay J.","family":"Kirtane","sequence":"additional","affiliation":[{"name":"Columbia University Irving Medical Center\/NewYork-Presbyterian Hospital, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"10304","key":"jrv260004r1","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1016\/S0140-6736(21)01330-1","article-title":"Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.","volume":"398","author":"NCD Risk Factor Collaboration (NCD-RisC)","year":"2021","journal-title":"Lancet"},{"issue":"6","key":"jrv260004r2","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.1161\/HYPERTENSIONAHA.123.20900","article-title":"Hypertension statistics for US adults: an open-source web application for analysis and visualization of National Health and Nutrition Examination Survey data.","volume":"80","author":"Jaeger","year":"2023","journal-title":"Hypertension"},{"issue":"11","key":"jrv260004r3","doi-asserted-by":"publisher","first-page":"e114","DOI":"10.1161\/CIR.0000000000001356","article-title":"AHA\/ACC\/AANP\/AAPA\/ABC\/ACCP\/ACPM\/AGS\/AMA\/ASPC\/NMA\/PCNA\/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines.","volume":"152","author":"Jones","year":"2025","journal-title":"Circulation"},{"issue":"6","key":"jrv260004r4","doi-asserted-by":"publisher","first-page":"1953","DOI":"10.1161\/HYPERTENSIONAHA.120.15890","article-title":"Cardiovascular health and transition from controlled blood pressure to apparent treatment resistant hypertension: the Jackson Heart Study and the REGARDS Study.","volume":"76","author":"Akinyelure","year":"2020","journal-title":"Hypertension"},{"issue":"2","key":"jrv260004r5","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1136\/heartjnl-2018-313599","article-title":"Global prevalence of resistant hypertension: a meta-analysis of data from 3.2 million patients.","volume":"105","author":"Noubiap","year":"2019","journal-title":"Heart"},{"issue":"9","key":"jrv260004r6","doi-asserted-by":"publisher","first-page":"1583","DOI":"10.2215\/CJN.00550113","article-title":"Prevalence of apparent treatment-resistant hypertension among individuals with CKD.","volume":"8","author":"Tanner","year":"2013","journal-title":"Clin J Am Soc Nephrol"},{"issue":"10","key":"jrv260004r7","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1016\/j.mayocp.2013.06.017","article-title":"Characteristics of resistant hypertension in a large, ethnically diverse hypertension population of an integrated health system.","volume":"88","author":"Sim","year":"2013","journal-title":"Mayo Clin Proc"},{"issue":"1","key":"jrv260004r8","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.08.010405","article-title":"Association of obstructive sleep apnea with hypertension: a systematic review and meta-analysis.","volume":"8","author":"Hou","year":"2018","journal-title":"J Glob Health"},{"issue":"8","key":"jrv260004r9","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.1161\/HYPERTENSIONAHA.124.22703","article-title":"Alcohol intake and risk of hypertension: a systematic review and dose-response meta-analysis of nonexperimental cohort studies.","volume":"81","author":"Cecchini","year":"2024","journal-title":"Hypertension"},{"issue":"1","key":"jrv260004r10","doi-asserted-by":"publisher","first-page":"e7","DOI":"10.1161\/CIR.0000000000001341","article-title":"Alcohol use and cardiovascular disease: a scientific statement from the American Heart Association.","volume":"152","author":"Piano","year":"2025","journal-title":"Circulation"},{"key":"jrv260004r11","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1146\/annurev-med-042711-135929","article-title":"Hyperaldosteronism as a common cause of resistant hypertension.","volume":"64","author":"Calhoun","year":"2013","journal-title":"Annu Rev Med"},{"issue":"8","key":"jrv260004r12","doi-asserted-by":"publisher","first-page":"1346","DOI":"10.1161\/HYPERTENSIONAHA.125.24749","article-title":"Sympathetic overactivation in the resistant hypertensive phenotype: a meta-analysis of published studies.","volume":"82","author":"Grassi","year":"2025","journal-title":"Hypertension"},{"issue":"10367","key":"jrv260004r13","doi-asserted-by":"publisher","first-page":"1927","DOI":"10.1016\/S0140-6736(22)02034-7","article-title":"Dual endothelin antagonist aprocitentan for resistant hypertension (PRECISION): a multicentre, blinded, randomised, parallel-group, phase 3 trial.","volume":"400","author":"Schlaich","year":"2022","journal-title":"Lancet"},{"issue":"12","key":"jrv260004r14","doi-asserted-by":"publisher","first-page":"2458","DOI":"10.1097\/HJH.0000000000001106","article-title":"Copeptin is increased in resistant hypertension.","volume":"34","author":"Mendes","year":"2016","journal-title":"J Hypertens"},{"issue":"36","key":"jrv260004r15","doi-asserted-by":"publisher","first-page":"3741","DOI":"10.1093\/eurheartj\/ehab499","article-title":"Sacubitril-valsartan as a treatment for apparent resistant hypertension in patients with heart failure and preserved ejection fraction.","volume":"42","author":"Jackson","year":"2021","journal-title":"Eur Heart J"},{"issue":"11","key":"jrv260004r16","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1038\/jhh.2011.43","article-title":"Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension.","volume":"25","author":"Quinaglia","year":"2011","journal-title":"J Hum Hypertens"},{"issue":"11","key":"jrv260004r17","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1001\/archinte.168.11.1159","article-title":"Characterization of resistant hypertension: association between resistant hypertension, aldosterone, and persistent intravascular volume expansion.","volume":"168","author":"Gaddam","year":"2008","journal-title":"Arch Intern Med"},{"issue":"6","key":"jrv260004r18","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1016\/j.jacc.2019.11.055","article-title":"Salt reduction to prevent hypertension and cardiovascular disease: JACC state-of-the-art review.","volume":"75","author":"He","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"jrv260004r19","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1097\/HJH.0000000000003563","article-title":"Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension.","volume":"42","author":"Charchar","year":"2024","journal-title":"J Hypertens"},{"issue":"7","key":"jrv260004r20","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1056\/NEJMoa1311989","article-title":"Association of urinary sodium and potassium excretion with blood pressure.","volume":"371","author":"Mente","year":"2014","journal-title":"N Engl J Med"},{"issue":"8","key":"jrv260004r21","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1007\/s11906-014-0459-3","article-title":"Sleep disturbances and resistant hypertension: association or causality?","volume":"16","author":"Genta-Pereira","year":"2014","journal-title":"Curr Hypertens Rep"},{"issue":"6","key":"jrv260004r22","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1038\/jhh.2014.94","article-title":"Pathogenesis of obstructive sleep apnoea in hypertensive patients: role of fluid retention and nocturnal rostral fluid shift.","volume":"29","author":"White","year":"2015","journal-title":"J Hum Hypertens"},{"issue":"12","key":"jrv260004r23","doi-asserted-by":"publisher","first-page":"1874","DOI":"10.1097\/HJH.0000000000003480","article-title":"2023 ESH guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA).","volume":"41","author":"Mancia","year":"2023","journal-title":"J Hypertens"},{"issue":"38","key":"jrv260004r24","doi-asserted-by":"publisher","first-page":"3912","DOI":"10.1093\/eurheartj\/ehae178","article-title":"2024 ESC guidelines for the management of elevated blood pressure and hypertension.","volume":"45","author":"McEvoy","year":"2024","journal-title":"Eur Heart J"},{"issue":"5","key":"jrv260004r25","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1161\/HYPERTENSIONAHA.110.168948","article-title":"Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring.","volume":"57","author":"de la Sierra","year":"2011","journal-title":"Hypertension"},{"issue":"1","key":"jrv260004r26","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1161\/HYP.0000000000000203","article-title":"Medication adherence and blood pressure control: a scientific statement from the American Heart Association.","volume":"79","author":"Choudhry","year":"2022","journal-title":"Hypertension"},{"issue":"5","key":"jrv260004r27","doi-asserted-by":"publisher","first-page":"e53","DOI":"10.1161\/HYP.0000000000000084","article-title":"Resistant hypertension: detection, evaluation, and management: a scientific statement from the American Heart Association.","volume":"72","author":"Carey","year":"2018","journal-title":"Hypertension"},{"issue":"1","key":"jrv260004r28","doi-asserted-by":"publisher","first-page":"10","DOI":"10.7326\/M20-0065","article-title":"The unrecognized prevalence of primary aldosteronism: a cross-sectional study.","volume":"173","author":"Brown","year":"2020","journal-title":"Ann Intern Med"},{"issue":"9","key":"jrv260004r29","doi-asserted-by":"publisher","first-page":"2453","DOI":"10.1210\/clinem\/dgaf284","article-title":"Primary aldosteronism: an endocrine society clinical practice guideline.","volume":"110","author":"Adler","year":"2025","journal-title":"J Clin Endocrinol Metab"},{"issue":"pt A","key":"jrv260004r30","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.ejphar.2015.06.027","article-title":"Drug induced hypertension\u2014an unappreciated cause of secondary hypertension.","volume":"763","author":"Grossman","year":"2015","journal-title":"Eur J Pharmacol"},{"issue":"1","key":"jrv260004r31","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1001\/jamainternmed.2021.6819","article-title":"Prevalence of medications that may raise blood pressure among adults with hypertension in the United States.","volume":"182","author":"Vitarello","year":"2022","journal-title":"JAMA Intern Med"},{"issue":"10285","key":"jrv260004r32","doi-asserted-by":"publisher","first-page":"1625","DOI":"10.1016\/S0140-6736(21)00590-0","article-title":"Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis.","volume":"397","author":"Blood Pressure Lowering Treatment Trialists\u2019 Collaboration","year":"2021","journal-title":"Lancet"},{"issue":"10305","key":"jrv260004r33","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.1016\/S0140-6736(21)01921-8","article-title":"Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis.","volume":"398","author":"Blood Pressure Lowering Treatment Trialists\u2019 Collaboration","year":"2021","journal-title":"Lancet"},{"issue":"19","key":"jrv260004r34","doi-asserted-by":"publisher","first-page":"1646","DOI":"10.1001\/jama.2024.4175","article-title":"Associations between surrogate markers and clinical outcomes for nononcologic chronic disease treatments.","volume":"331","author":"Wallach","year":"2024","journal-title":"JAMA"},{"issue":"20","key":"jrv260004r35","doi-asserted-by":"publisher","first-page":"1608","DOI":"10.1136\/heartjnl-2022-321332","article-title":"Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis.","volume":"108","author":"Yin","year":"2022","journal-title":"Heart"},{"issue":"5","key":"jrv260004r36","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1161\/01.HYP.0000094221.86888.AE","article-title":"Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials.","volume":"42","author":"Neter","year":"2003","journal-title":"Hypertension"},{"issue":"15","key":"jrv260004r37","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.1161\/CIRCULATIONAHA.121.055329","article-title":"Effects of lifestyle modification on patients with resistant hypertension: results of the TRIUMPH randomized clinical trial.","volume":"144","author":"Blumenthal","year":"2021","journal-title":"Circulation"},{"issue":"11","key":"jrv260004r38","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1001\/jamacardio.2021.2735","article-title":"Effect of exercise training on ambulatory blood pressure among patients with resistant hypertension: a randomized clinical trial.","volume":"6","author":"Lopes","year":"2021","journal-title":"JAMA Cardiol"},{"issue":"2","key":"jrv260004r39","doi-asserted-by":"publisher","first-page":"e108","DOI":"10.1016\/S2468-2667(17)30003-8","article-title":"The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis.","volume":"2","author":"Roerecke","year":"2017","journal-title":"Lancet Public Health"},{"key":"jrv260004r40","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2025.2318","article-title":"Diagnosis and treatment of obstructive sleep apnea.","author":"Lastra","year":"2025","journal-title":"JAMA Intern Med"},{"issue":"5","key":"jrv260004r41","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1007\/s11906-024-01294-4","article-title":"Effect of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: an updated meta-analysis.","volume":"26","author":"Sun","year":"2024","journal-title":"Curr Hypertens Rep"},{"issue":"2","key":"jrv260004r42","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1161\/HYPERTENSIONAHA.120.15781","article-title":"Adherence to single-pill versus free-equivalent combination therapy in hypertension: a systematic review and meta-analysis.","volume":"77","author":"Parati","year":"2021","journal-title":"Hypertension"},{"issue":"5","key":"jrv260004r43","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1161\/HYPERTENSIONAHA.114.05021","article-title":"Head-to-head comparisons of hydrochlorothiazide with indapamide and chlorthalidone: antihypertensive and metabolic effects.","volume":"65","author":"Roush","year":"2015","journal-title":"Hypertension"},{"issue":"26","key":"jrv260004r44","doi-asserted-by":"publisher","first-page":"2401","DOI":"10.1056\/NEJMoa2212270","article-title":"Chlorthalidone vs hydrochlorothiazide for hypertension-cardiovascular events.","volume":"387","author":"Ishani","year":"2022","journal-title":"N Engl J Med"},{"issue":"27","key":"jrv260004r45","doi-asserted-by":"publisher","first-page":"2507","DOI":"10.1056\/NEJMoa2110730","article-title":"Chlorthalidone for hypertension in advanced chronic kidney disease.","volume":"385","author":"Agarwal","year":"2021","journal-title":"N Engl J Med"},{"issue":"1","key":"jrv260004r46","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1097\/HJH.0000000000000762","article-title":"Dose doubling, relative potency, and dose equivalence of potassium-sparing diuretics affecting blood pressure and serum potassium: systematic review and meta-analyses.","volume":"34","author":"Roush","year":"2016","journal-title":"J Hypertens"},{"issue":"6218","key":"jrv260004r47","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1136\/bmj.280.6218.905","article-title":"Hypokalaemia and diuretics: an analysis of publications.","volume":"280","author":"Morgan","year":"1980","journal-title":"BMJ"},{"issue":"2","key":"jrv260004r48","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1111\/j.1365-2125.1982.tb01970.x","article-title":"Relative potency of spironolactone, triamterene and potassium chloride in thiazide-induced hypokalaemia.","volume":"14","author":"Jackson","year":"1982","journal-title":"Br J Clin Pharmacol"},{"issue":"16","key":"jrv260004r49","doi-asserted-by":"publisher","first-page":"1256","DOI":"10.1056\/NEJMra020676","article-title":"Renal dysfunction complicating the treatment of hypertension.","volume":"347","author":"Palmer","year":"2002","journal-title":"N Engl J Med"},{"issue":"10","key":"jrv260004r50","doi-asserted-by":"publisher","first-page":"1973","DOI":"10.1093\/ndt\/gfg282","article-title":"Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: what to do if the serum creatinine and\/or serum potassium concentration rises.","volume":"18","author":"Palmer","year":"2003","journal-title":"Nephrol Dial Transplant"},{"issue":"10","key":"jrv260004r51","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1007\/s11886-020-01365-3","article-title":"Intensive BP control and eGFR declines: are these events due to hemodynamic effects and are changes reversible?","volume":"22","author":"Chen","year":"2020","journal-title":"Curr Cardiol Rep"},{"issue":"5","key":"jrv260004r52","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1161\/HYPERTENSIONAHA.120.14784","article-title":"Early decline in kidney function with intensive systolic blood pressure lowering: does it matter?","volume":"75","author":"Beddhu","year":"2020","journal-title":"Hypertension"},{"issue":"12","key":"jrv260004r53","doi-asserted-by":"publisher","first-page":"2835","DOI":"10.1093\/ndt\/gfad095","article-title":"Atherosclerotic renovascular disease: a clinical practice document by the European Renal Best Practice (ERBP) board of the European Renal Association (ERA) and the Working Group Hypertension and the Kidney of the European Society of Hypertension (ESH).","volume":"38","author":"Sarafidis","year":"2023","journal-title":"Nephrol Dial Transplant"},{"issue":"1","key":"jrv260004r54","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1093\/cvr\/cvad165","article-title":"Efficacy of pharmacological and interventional treatment for resistant hypertension: a network meta-analysis.","volume":"120","author":"Tian","year":"2024","journal-title":"Cardiovasc Res"},{"issue":"2","key":"jrv260004r55","article-title":"Eplerenone for hypertension.","volume":"2","author":"Tam","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"issue":"8","key":"jrv260004r56","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1016\/S0895-7061(02)02957-6","article-title":"Eplerenone, a selective aldosterone blocker, in mild-to-moderate hypertension.","volume":"15","author":"Weinberger","year":"2002","journal-title":"Am J Hypertens"},{"issue":"6","key":"jrv260004r57","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1016\/S2213-8587(18)30071-8","article-title":"Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: the PATHWAY-2 mechanisms substudies.","volume":"6","author":"Williams","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"23","key":"jrv260004r58","doi-asserted-by":"publisher","first-page":"2073","DOI":"10.1001\/jama.2025.5129","article-title":"Spironolactone vs amiloride for resistant hypertension: a randomized clinical trial.","volume":"333","author":"Lee","year":"2025","journal-title":"JAMA"},{"issue":"4","key":"jrv260004r59","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1161\/HYPERTENSIONAHA.117.10662","article-title":"Spironolactone versus clonidine as a fourth-drug therapy for resistant hypertension: the ReHOT randomized study (Resistant Hypertension Optimal Treatment).","volume":"71","author":"Krieger","year":"2018","journal-title":"Hypertension"},{"issue":"3","key":"jrv260004r60","doi-asserted-by":"publisher","DOI":"10.1002\/prp2.1215","article-title":"Not first-line antihypertensive agents, but still effective\u2014the efficacy and safety of imidazoline receptor agonists: a network meta-analysis.","volume":"12","author":"\u00c9rszegi","year":"2024","journal-title":"Pharmacol Res Perspect"},{"issue":"34","key":"jrv260004r61","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000021694","article-title":"Clinical efficacy and safety of spironolactone in patients with resistant hypertension: a systematic review and meta-analysis.","volume":"99","author":"Chen","year":"2020","journal-title":"Medicine (Baltimore)"},{"issue":"7","key":"jrv260004r62","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1093\/ndt\/gfae056","article-title":"Hyperkalemia treatment standard.","volume":"39","author":"Palmer","year":"2024","journal-title":"Nephrol Dial Transplant"},{"issue":"10208","key":"jrv260004r63","doi-asserted-by":"publisher","first-page":"1540","DOI":"10.1016\/S0140-6736(19)32135-X","article-title":"Patiromer versus placebo to enable spironolactone use in patients with resistant hypertension and chronic kidney disease (AMBER): a phase 2, randomised, double-blind, placebo-controlled trial.","volume":"394","author":"Agarwal","year":"2019","journal-title":"Lancet"},{"issue":"3","key":"jrv260004r64","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1056\/NEJMoa1411487","article-title":"Sodium zirconium cyclosilicate in hyperkalemia.","volume":"372","author":"Packham","year":"2015","journal-title":"N Engl J Med"},{"issue":"3","key":"jrv260004r65","first-page":"37","article-title":"Oral spironolactone in post-teenage female patients with acne vulgaris: practical considerations for the clinician based on current data and clinical experience.","volume":"5","author":"Kim","year":"2012","journal-title":"J Clin Aesthet Dermatol"},{"issue":"1-2","key":"jrv260004r66","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.mce.2003.10.008","article-title":"The 45-year story of the development of an anti-aldosterone more specific than spironolactone.","volume":"217","author":"M\u00e9nard","year":"2004","journal-title":"Mol Cell Endocrinol"},{"issue":"10","key":"jrv260004r67","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1056\/NEJM199909023411001","article-title":"The effect of spironolactone on morbidity and mortality in patients with severe heart failure.","volume":"341","author":"Pitt","year":"1999","journal-title":"N Engl J Med"},{"issue":"22","key":"jrv260004r68","doi-asserted-by":"publisher","first-page":"3263","DOI":"10.1001\/jama.1985.03350460063022","article-title":"Long-term surveillance for adverse effects of antihypertensive drugs.","volume":"253","author":"Curb","year":"1985","journal-title":"JAMA"},{"issue":"7","key":"jrv260004r69","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.1097\/HJH.0000000000002382","article-title":"Update of the position paper on arterial hypertension and erectile dysfunction.","volume":"38","author":"Viigimaa","year":"2020","journal-title":"J Hypertens"},{"issue":"1","key":"jrv260004r70","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/HJH.0b013e3283599b6a","article-title":"Spironolactone, eplerenone and the new aldosterone blockers in endocrine and primary hypertension.","volume":"31","author":"Colussi","year":"2013","journal-title":"J Hypertens"},{"issue":"10008","key":"jrv260004r71","doi-asserted-by":"publisher","first-page":"2059","DOI":"10.1016\/S0140-6736(15)00257-3","article-title":"Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial.","volume":"386","author":"Williams","year":"2015","journal-title":"Lancet"},{"issue":"4","key":"jrv260004r72","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1161\/HYPERTENSIONAHA.124.24142","article-title":"Aprocitentan for blood pressure reduction in Black patients.","volume":"82","author":"Flack","year":"2025","journal-title":"Hypertension"},{"issue":"10","key":"jrv260004r73","doi-asserted-by":"publisher","first-page":"e135","DOI":"10.1161\/HYP.0000000000000240","article-title":"Renal denervation for the treatment of hypertension: a scientific statement from the American Heart Association.","volume":"81","author":"Cluett","year":"2024","journal-title":"Hypertension"},{"issue":"15","key":"jrv260004r74","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.1093\/eurheartj\/ehad054","article-title":"Renal denervation in the management of hypertension in adults: a clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI).","volume":"44","author":"Barbato","year":"2023","journal-title":"Eur Heart J"},{"issue":"10293","key":"jrv260004r75","doi-asserted-by":"publisher","first-page":"2476","DOI":"10.1016\/S0140-6736(21)00788-1","article-title":"Ultrasound renal denervation for hypertension resistant to a triple medication pill (RADIANCE-HTN TRIO): a randomised, multicentre, single-blind, sham-controlled trial.","volume":"397","author":"Azizi","year":"2021","journal-title":"Lancet"},{"issue":"19","key":"jrv260004r76","doi-asserted-by":"publisher","first-page":"1809","DOI":"10.1016\/j.jacc.2023.08.045","article-title":"Safety and efficacy of renal denervation in patients taking antihypertensive medications.","volume":"82","author":"Kandzari","year":"2023","journal-title":"J Am Coll Cardiol"},{"issue":"20","key":"jrv260004r77","doi-asserted-by":"publisher","first-page":"1588","DOI":"10.1161\/CIRCULATIONAHA.124.069215","article-title":"Efficacy and safety of catheter-based radiofrequency renal denervation in Chinese patients with uncontrolled hypertension: the randomized, sham-controlled, multi-center Iberis-HTN trial.","volume":"150","author":"Jiang","year":"2024","journal-title":"Circulation"},{"issue":"12","key":"jrv260004r78","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.1001\/jamacardio.2022.3904","article-title":"Effects of renal denervation vs sham in resistant hypertension after medication escalation: prespecified analysis at 6 months of the RADIANCE-HTN TRIO randomized clinical trial.","volume":"7","author":"Azizi","year":"2022","journal-title":"JAMA Cardiol"},{"issue":"20","key":"jrv260004r79","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.1161\/CIRCULATIONAHA.124.069709","article-title":"Effects of catheter-based renal denervation in hypertension: a systematic review and meta-analysis.","volume":"150","author":"Vukadinovic","year":"2024","journal-title":"Circulation"},{"key":"jrv260004r80","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwaf368","article-title":"Long-term outcomes following radiofrequency renal denervation: meta-analysis of 18 reports.","author":"Mahfoud","year":"2025","journal-title":"Eur J Prev Cardiol"},{"issue":"1","key":"jrv260004r81","doi-asserted-by":"publisher","first-page":"89","DOI":"10.4244\/EIJ-D-19-00902","article-title":"Review and meta-analysis of renal artery damage following percutaneous renal denervation with radiofrequency renal artery ablation.","volume":"16","author":"Townsend","year":"2020","journal-title":"EuroIntervention"},{"issue":"11","key":"jrv260004r82","doi-asserted-by":"publisher","first-page":"2063","DOI":"10.1097\/00004872-200111000-00018","article-title":"High prevalence of cardiac and extracardiac target organ damage in refractory hypertension.","volume":"19","author":"Cuspidi","year":"2001","journal-title":"J Hypertens"},{"issue":"11","key":"jrv260004r83","doi-asserted-by":"publisher","first-page":"2350","DOI":"10.1161\/HYPERTENSIONAHA.124.23276","article-title":"Resistant hypertension and mortality: an observational cohort study.","volume":"81","author":"de la Sierra","year":"2024","journal-title":"Hypertension"},{"issue":"14","key":"jrv260004r84","doi-asserted-by":"publisher","first-page":"1363","DOI":"10.1056\/NEJMoa2507109","article-title":"Efficacy and safety of baxdrostat in uncontrolled and resistant hypertension.","volume":"393","author":"Flack","year":"2025","journal-title":"N Engl J Med"},{"issue":"18","key":"jrv260004r85","doi-asserted-by":"publisher","first-page":"1813","DOI":"10.1056\/NEJMoa2501440","article-title":"Lorundrostat efficacy and safety in patients with uncontrolled hypertension.","volume":"392","author":"Laffin","year":"2025","journal-title":"N Engl J Med"},{"issue":"12","key":"jrv260004r86","doi-asserted-by":"publisher","first-page":"2256","DOI":"10.1161\/ATVBAHA.123.319897","article-title":"Targeting angiotensinogen with N-acetylgalactosamine-conjugated small interfering RNA to reduce blood pressure.","volume":"43","author":"Ye","year":"2023","journal-title":"Arterioscler Thromb Vasc Biol"},{"issue":"1","key":"jrv260004r87","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1001\/jama.2025.6681","article-title":"Add-on treatment with zilebesiran for inadequately controlled hypertension: the KARDIA-2 randomized clinical trial.","volume":"334","author":"Desai","year":"2025","journal-title":"JAMA"}],"container-title":["JAMA"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/articlepdf\/2846682\/jama_azizi_2026_rv_260004_1776721404.39851.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:01:09Z","timestamp":1777388469000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2846682"}},"subtitle":["A Review"],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":87,"journal-issue":{"issue":"16","published-print":{"date-parts":[[2026,4,28]]}},"URL":"https:\/\/doi.org\/10.1001\/jama.2026.1221","relation":{},"ISSN":["0098-7484"],"issn-type":[{"value":"0098-7484","type":"print"}],"subject":[],"published":{"date-parts":[[2026,4,28]]}}}