Adding a single pharmacological or device-based intervention in true resistant hypertension reduced 24-hour systolic ambulatory BP by a pooled mean of 11.3 mmHg (95% CI: -12.3, -10.2).
Meta-Analysis (n=6,297)
Does the addition of a single pharmacological or device-based intervention reduce blood pressure and improve hypertension control in patients with true resistant hypertension?
Adding a single pharmacological or device-based intervention in resistant hypertension yields clinically meaningful BP reductions, though only about one-third of patients achieve BP control.
Mean Difference: -11.3 (95% CI -12.3–-10.2)
Objective: Resistant hypertension (RHTN) remains a major clinical challenge. 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. Design and method: 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. Conclusions: 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.
Kyriakoulis et al. (2026) conducted a meta-analysis in Resistant hypertension (n=6,297). Pharmacological or device-based interventions (renal denervation) vs. Baseline was evaluated on 24-hour systolic ambulatory BP reduction from baseline (MD -11.3, 95% CI -12.3, -10.2). Adding a single pharmacological or device-based intervention in true resistant hypertension reduced 24-hour systolic ambulatory BP by a pooled mean of 11.3 mmHg (95% CI: -12.3, -10.2).