What do systematic reviews say?

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