What do systematic reviews say?

First‐line angiotensin converting enzyme inhibitor vs placebo

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

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  RR 0.81 [0.7, 0.94]
  2 studies · 5145 participants
  Moderate

First‐line beta‐blocker vs placebo

First‐line beta‐blocker showed no clear difference in total coronary heart disease compared with placebo (low certainty).

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  RR 0.9 [0.78, 1.03]
  5 studies · 19313 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
  Low

Beta‐blockers vs renin‐angiotensin system inhibitors

Beta‐blockers showed no clear difference in total coronary heart disease compared with renin‐angiotensin system inhibitors (low certainty).

• Beta‐blockers for hypertension 2017 · Cochrane Headline outcomes only
  RR 0.9 [0.76, 1.06]
  2 studies · 9951 participants
  Low

First‐line calcium channel blocker vs placebo

First‐line calcium channel blocker showed no clear difference in total coronary heart disease (CHD) compared with placebo (low certainty).

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  RR 0.77 [0.55, 1.09]
  1 study · 4695 participants
  Low

Beta‐blockers vs calcium channel blockers

Beta‐blockers showed no clear difference in total coronary heart disease compared with calcium‐channel blockers (moderate certainty).

• Beta‐blockers for hypertension 2017 · Cochrane Headline outcomes only
  RR 1.05 [0.96, 1.15]
  3 studies · 44167 participants
  Moderate

Beta‐blockers vs placebo

Beta‐blockers showed no clear difference in total coronary heart disease compared with placebo (moderate certainty).

• Beta‐blockers for hypertension 2017 · Cochrane Headline outcomes only
  RR 0.93 [0.81, 1.07]
  4 studies · 23613 participants
  Moderate

Beta‐blockers vs diuretics

Beta‐blockers showed no clear difference in total coronary heart disease compared with diuretics (low certainty).

• Beta‐blockers for hypertension 2017 · Cochrane Headline outcomes only
  RR 1.12 [0.82, 1.54]
  4 studies · 18135 participants
  Low