{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:03:22Z","timestamp":1792623802004,"version":"4.5.0"},"reference-count":67,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T00:00:00Z","timestamp":1698364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Resistant hypertension is associated with a high risk of cardiovascular disease, chronic kidney disease, and mortality. Yet, its management is challenging. This study aims to establish the comparative effectiveness of pharmacologic and interventional treatments by conducting a network meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>MEDLINE, Cochrane Register of Controlled Trials, and Web of Science Core Collection were systematically searched in March 2022. Randomized controlled trials comparing treatment options for management of resistant hypertension were included. Outcomes were blood pressure (BP) changes, measured in the office and in 24\u2005h ambulatory BP measurement. We applied a frequentist random effects model to perform a network meta-analysis combining placebo medication and sham procedure as the reference comparator. From 4771 records, 24 studies met the inclusion criteria with 3458 included patients in total. Twelve active treatment alternatives [spironolactone, doxazosin, \u03b2-blocker, clonidine, darusentan, guanfacine, various types of renal sympathetic denervation, lifestyle intervention, continuous positive airway pressure, and baroreflex activation therapy (BAT)] were analysed. Among all comparators, spironolactone had the highest ranking probability and was considered the most effective treatment to reduce office systolic blood pressure (sBP) [\u221213.30\u2005mmHg (\u221217.89; \u22128.72); P &amp;lt; 0.0001] and 24\u2005h sBP [\u22128.46\u2005mmHg (\u221212.54; \u22124.38); P &amp;lt; 0.0001] in patients with resistant hypertension. Lifestyle interventions were the most effective non-pharmacological treatment, lowering office sBP by \u22127.26\u2005mmHg (\u221213.73; \u22120.8), whereas BAT lowered office sBP by \u22127.0 (\u221218.59; 4.59). Renal denervation lowered office sBP by \u22125.64\u2005mmHg (\u221212.95; 1.66) and \u22123.79\u2005mmHg (\u221211.39; 3.8) depending on the type of the procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among all pharmacologic and interventional treatments, spironolactone is the most effective treatment in reducing BP in patients with resistant hypertension. More comparative trials and especially trials with long-term follow-up are needed. In the meanwhile, we have to conclude that a combination of spironolactone and lifestyle modification are the most effective treatments in resistant hypertension.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cvr\/cvad165","type":"journal-article","created":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T14:37:49Z","timestamp":1698417469000},"page":"108-119","source":"Crossref","is-referenced-by-count":39,"title":["Efficacy of pharmacological and interventional treatment for resistant hypertension: a network meta-analysis"],"prefix":"10.1093","volume":"120","author":[{"given":"Zhejia","family":"Tian","sequence":"first","affiliation":[{"name":"Department of Nephrology and Hypertension, Hannover Medical School , Carl-Neuberg-Stra\u00dfe 1 , Hannover 30625, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9180-0278","authenticated-orcid":false,"given":"Clara","family":"Vollmer Barbosa","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, Hannover Medical School , Carl-Neuberg-Stra\u00dfe 1 , Hannover 30625, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Lang","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, Hannover Medical School , Carl-Neuberg-Stra\u00dfe 1 , Hannover 30625, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9341-117X","authenticated-orcid":false,"given":"Johann","family":"Bauersachs","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Hannover Medical School , Hannover , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8164-6318","authenticated-orcid":false,"given":"Anette","family":"Melk","sequence":"additional","affiliation":[{"name":"Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School , Hannover , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7351-565X","authenticated-orcid":false,"given":"Bernhard M W","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, Hannover Medical School , Carl-Neuberg-Stra\u00dfe 1 , Hannover 30625, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,10,27]]},"reference":[{"key":"2024022722273918400_cvad165-B1","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990\u20132019: update from the GBD 2019 study","volume":"76","author":"Roth","year":"2020","journal-title":"J Am Coll 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