Background: Resistant hypertension presents a clinical challenge. The efficacy of renal denervation (RDN) as a potential treatment has conflicting data. Multiple randomized controlled trials have been conducted to assess the impact of RDN.

Methods: We performed systematic search of the PubMed and EMBASE from inception to April 2024 to identify studies comparing various interventions for resistant hypertension. We employed a frequentist network meta-analysis model, utilizing the net-meta module and applying a random effects model in CRAN-R software.

Results: Data of 2553 patients from 20 RCTs was analyzed. Standard mean differences (SMDs) for diastolic blood pressure (DBP) and systolic blood pressure (SBP) were assessed at different time points, including daytime, nighttime, over 24 hours, and during office visits. Our results demonstrate an improvement in various BP parameters when comparing RDN with sham: daytime DBP (3.46, 95%CI: [1.89-5.02], P < 0.0001), nighttime SBP(2.87, 95%CI: [1.43-4.31], P < 0.0001), 24-hour SBP (2.82, 95%CI: [1.24-4.41], P = 0.001), and in-office DBP (2.70, 95%CI: [1.04-4.36], P = 0.002). However, no statistically significant difference was found in daytime SBP (3.60, 95% CI: [-0.67-7.87], P = 0.10), nighttime DBP (1.65, 95% CI: [-0.57-3.86], P = 0.15) and in-office SBP (3.89, 95% CI: [-10.07-17.86], P = 0.60) and in 24-hour DBP.

Conclusion: Our study supports the efficacy of RDN, when combined with antihypertensive treatment when compared to sham treatment, in the management of resistant hypertension.