What do systematic reviews say?

Lower blood pressure targets vs standard blood pressure targets

Lower blood pressure targets showed no clear difference in total cardiovascular events compared with standard blood pressure targets (low certainty).

• Blood pressure targets for the treatment of people with hypertension and cardiovascular disease 2022 · Cochrane Headline outcomes only
  RR 0.89 [0.8, 1]
  7 studies · 9595 participants
  Low

First‐line beta‐blocker vs placebo

First‐line beta‐blocker may leads to lower total cardiovascular events compared with placebo (low certainty).

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  RR 0.89 [0.81, 0.98]
  5 studies · 19313 participants
  Low

First‐line angiotensin converting enzyme inhibitor vs placebo

First‐line angiotensin converting enzyme inhibitor probably leads to lower total cardiovascular events compared with placebo (moderate certainty).

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  RR 0.76 [0.67, 0.85]
  2 studies · 5145 participants
  Moderate

First‐line calcium channel blocker vs placebo

First‐line calcium channel blocker may leads to lower total cardiovascular events compared with placebo (low certainty).

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  RR 0.71 [0.57, 0.87]
  1 study · 4695 participants
  Low

First‐line low‐dose thiazide vs placebo

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  no estimate extracted
  7 studies · 19022 participants
  High

First‐line high‐dose thiazide vs placebo

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  no estimate extracted
  11 studies · 19839 participants
  Moderate

RAS inhibitors vs beta‐blocker

RAS inhibitors may leads to lower total cardiovascular events compared with beta‐blockers (low certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 0.88 [0.8, 0.98]
  2 studies · 9239 participants
  Low

RAS inhibitors vs CCBs

RAS inhibitors showed no clear difference in total cardiovascular events compared with CCBs (moderate certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 0.98 [0.93, 1.02]
  6 studies · 35223 participants
  Moderate

RAS inhibitors vs thiazides

RAS inhibitors showed no clear difference in total cardiovascular events compared with thiazides (moderate certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 1.05 [1, 1.11]
  2 studies · 24379 participants
  Moderate

Angiotensin‐converting enzyme inhibitors vs ARB

All angiotensin converting enzyme (ACE) inhibitors showed no clear difference in total cardiovascular events compared with all angiotensin receptor blockers (ARBs) (low certainty).

• Angiotensin converting enzyme (ACE) inhibitors versus angiotensin receptor blockers for primary hypertension 2014 · Cochrane Headline outcomes only
  RR 1.07 [0.96, 1.19]
  3 studies · 5499 participants
  Low

First‐line thiazides vs calcium channel blockers

First‐line thiazides probably leads to lower total cardiovascular events Duration: 1 to 5 years compared with first‐line calcium channel blockers (moderate certainty).

• First‐line diuretics versus other classes of antihypertensive drugs for hypertension 2023 · Cochrane Headline outcomes only
  RR 0.93 [0.89, 0.98]
  6 studies · 35217 participants
  Moderate

First‐line thiazides vs ACE inhibitor

First‐line thiazides showed no clear difference in total cardiovascular events Duration: 2.6 to 5 years compared with first‐line ACE inhibitors (low certainty).

• First‐line diuretics versus other classes of antihypertensive drugs for hypertension 2023 · Cochrane Headline outcomes only
  RR 0.97 [0.92, 1.02]
  3 studies · 30900 participants
  Low

First‐line thiazides vs alpha‐blocker

First‐line thiazides probably leads to lower total cardiovascular events Duration: 3 to 3.2 years compared with first‐line alpha‐blockers (moderate certainty).

• First‐line diuretics versus other classes of antihypertensive drugs for hypertension 2023 · Cochrane Headline outcomes only
  RR 0.74 [0.69, 0.8]
  2 studies · 24396 participants
  Moderate

First‐line thiazides vs beta‐blocker

• First‐line diuretics versus other classes of antihypertensive drugs for hypertension 2023 · Cochrane Headline outcomes only
  no estimate extracted
  4 studies · 18135 participants
  Moderate