Abstract 10114: A Systematic Review, Meta-Analysis of Sham and Placebo Controlled Trials Testing Spironolactone and Renal Denervation as Treatments for Resistant Hypertension

Abstract

Introduction: The most common 4 th -line treatment for resistant hypertension (RHTN) is the addition of a mineralocorticoid receptor antagonist (MRA). Renal denervation (RD) has also been investigated as a treatment option for RHTN. A lack of data on the comparative effectiveness of these two therapies poses challenges in choosing optimal treatment strategies for patients with RHTN. Methods: Placebo-controlled and sham-controlled randomized clinical trials testing spironolactone or RD as treatments for RHTN were included in this analysis. Prespecified subgroup analyses comparing the efficacy of MRA and RD were conducted for the outcomes of 24-hour blood pressure (BP) and office BP. Results: Fourteen studies (8 MRA and 6 RD) were identified that included 2,306 participants (1,414 MRA and 892 RD). Cochran risk of bias assessment showed 84% of the domains to be low risk of bias for the MRA studies and 88% of the domains to be low risk of bias for the RD studies. The raw mean difference (RMD) between MRA and placebo control was statistically significant for 24-hour systolic (SBP) (-10.59 mmHg; 95% confidence interval (CI) -12.88 to -8.31), 24-hour diastolic (DBP) (-5.03 mmHg; 95% CI -6.75 to -3.32), office SBP (-10.43 mmHg; 95% CI -12.23 to -8.63), and office DBP (-4.10 mmHg; 95% CI -5.18 to -3.02). The RMD between RD and sham control was not statistically significant for 24-hour SBP (-1.85 mmHg; 95% CI -3.88 to 0.18), 24-hour DBP (-0.67 mmHg; 95% CI -1.84 to 0.51), office SBP (-1.93 mmHg; 95% CI -5.17 to 1.31), and office DBP (-1.55 mmHg; 95% CI -3.43 to 0.33). The interaction between the subgroups was statistically significant for all analyses. Discussion: MRAs had a greater reduction in 24-hour ambulatory and office BP compared to RD among patients with RHTN. This data may help physicians s counsel their patients regarding optimal treatment options for RHTN.