{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T03:54:39Z","timestamp":1791172479752,"version":"4.1.0"},"reference-count":56,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Hypertension"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Mineralocorticoid receptor antagonists (MRAs), aldosterone synthase inhibitors (ASIs), and epithelial sodium channel (ENaC) blockade target different levels of the aldosterone\u2010related sodium\u2010retention pathway in resistant hypertension (RH), but the comparative efficacy of individual agents remains uncertain. We conducted a focused drug\u2010level network meta\u2010analysis of randomized controlled trials (RCTs) comparing pathway\u2010directed therapies in adults with RH. PubMed, Scopus, Embase, Cochrane CENTRAL, Cochrane Reviews, and ClinicalTrials.gov were searched from inception to July 20, 2026. The primary outcome was change in office systolic blood pressure (BP). Secondary outcomes included office diastolic BP and 24\u2010hour ambulatory systolic and diastolic BP. Ten RCTs including 2865 participants were analyzed. In the primary drug\u2010level analysis, amiloride, spironolactone, baxdrostat, eplerenone, and lorundrostat significantly reduced office systolic BP compared with placebo, with mean differences (MDs) of \u221214.08, \u221210.78, \u22129.09, \u22128.14, and \u22126.80\u00a0mmHg, respectively. Osilodrostat showed a statistically uncertain effect, with an MD of \u22122.61\u00a0mmHg. At the class level, both MRAs and ASIs showed clinically meaningful reductions in office systolic BP. Secondary outcomes were generally consistent with the primary analysis, although fewer trials contributed to these networks. Sensitivity analyses did not materially change the primary findings. These results support the aldosterone\u2010related sodium\u2010retention pathway as an important therapeutic target in RH. MRAs remain the established reference add\u2010on therapy, whereas newer ASIs and amiloride may represent pathway\u2010based alternatives for selected patients.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Trial Registration<\/jats:bold>\n                    : INPLASY202670099\n                  <\/jats:p>","DOI":"10.1111\/jch.70365","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T09:56:39Z","timestamp":1789725399000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Efficacy of Aldosterone\u2010Related Sodium\u2010Retention Pathway Therapies for Resistant Hypertension: A Drug\u2010Level Network Meta\u2010Analysis of Randomized Controlled Trials"],"prefix":"10.1111","volume":"28","author":[{"given":"Yi\u2010Liang","family":"Tsou","sequence":"first","affiliation":[{"name":"Heart Failure Research Center Division of Cardiology Department of Internal Medicine Keelung Chang Gung Memorial Hospital  Keelung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu\u2010Hung","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Internal Medicine Keelung Chang Gung Memorial Hospital  Keelung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi\u2010Siou","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Internal Medicine Keelung Chang Gung Memorial Hospital  Keelung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia\u2010Liang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Keelung Chang Gung Memorial Hospital  Keelung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"issue":"10","key":"e_1_2_13_2_1","first-page":"e212","article-title":"2025 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":"82","author":"Jones D. 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