Blood pressure lowering effects of pharmacological and device-based interventions for resistant hypertension: a systematic review and meta-analysis
K Kyriakoulis, a Vakka, N Stamataki, F Tatakis, D Konstantinidis, C Mihas, S Soulaidopoulos, A Kasiakogias, A Kordalis, C Thomopoulos, M Doumas, G Stergiou, M Schlaich, M Bohm, K TsioufisAbstract
Background/Introduction
Resistant hypertension (RHTN) remains a major clinical challenge.
Purpose
This systematic review/meta-analysis evaluated the blood pressure (BP)-lowering efficacy and hypertension control rates achieved after the addition of pharmacological or device-based interventions (renal denervation, RDN) in patients with true RHTN.
Methods
A systematic search of MEDLINE/PubMed was performed to identify studies assessing the antihypertensive effects of adding a single pharmacological or device-based intervention in patients with true RHTN. Primary analyses were conducted using a single-arm framework.
Results
Sixty-eight studies were included (n=6,297; weighted mean age 60 years; males 60%; diabetes 35%; smoking 16%; cardiovascular disease 27%). Participants received an average of 4.8 antihypertensive medications, with baseline office BP 164/92 mmHg and 24-hour ambulatory BP 148/85 mmHg. The median follow-up was 6 months. Meta-analysis of 58 studies (n = 4,579; 52% RDN) demonstrated a pooled mean 24-hour systolic ambulatory BP reduction from baseline -11.3 mmHg (95% CI: -12.3, -10.2). Meta-analysis of 15 studies (n = 2,700; 15% RDN) showed a pooled hypertension control rate during follow-up 35% (95% CI: 28, 42). No significant differences were observed between RDN and pharmacotherapy or between randomized and non-randomized studies.
Conclusion(s)
Single intervention (pharmacological or RDN) on top of guideline-directed background therapy resulted in clinically meaningful BP reduction in patients with true RHTN, but only one-third achieved BP control. Combination treatment strategies integrating optimized pharmacological regimens with device-based interventions may offer more effective and durable BP control in this particularly challenging patient population.Figure