Comparative Effects of Angiotensin Receptor Blockers on Blood Pressure and Serum Urate in Patients With Hypertension and Hyperuricaemia: A Systematic Review and Network Meta‐Analysis

ABSTRACT

This systematic review and network meta‐analysis compared the urate‐lowering and antihypertensive effects of seven angiotensin receptor blockers used as monotherapy in adults with hypertension and elevated serum urate or hyperuricaemia. Randomised controlled trials comparing one angiotensin receptor blocker with placebo or another angiotensin receptor blocker were searched in eight databases from inception to 17 April 2025. Risk of bias was assessed using RoB 2. Pairwise meta‐analysis and frequentist network meta‐analysis with multivariate random‐effects models were performed. Treatment effects were expressed as mean differences with 95% confidence intervals, and rankings were estimated using surface under the cumulative ranking curve. Consistency was assessed using design‐by‐treatment interaction, loop‐specific and node‐splitting approaches; exploratory meta‐regression examined heterogeneity. Fifty‐five randomised controlled trials involving 4559 participants were included. In the full‐network primary analysis, allisartan and losartan generally ranked among the leading treatments for serum urate reduction, whereas valsartan ranked lowest. Allisartan also showed favourable systolic and diastolic blood pressure effects. Significant inconsistency was mainly concentrated in the losartan–valsartan–allisartan loop, and removing the direct valsartan–allisartan comparison shifted estimates towards a larger apparent allisartan benefit. Meta‐regression suggested that baseline serum urate and baseline systolic blood pressure were associated with serum urate treatment effects, but explained limited heterogeneity. Evidence for eprosartan and candesartan was sparse, with low or very low certainty for several comparisons. Allisartan and losartan may be favourable options when both urate reduction and blood pressure control are considered, but rankings should not be viewed as definitive superiority. PROSPERO: CRD420251007246.