What do systematic reviews say?

Aspirin vs placebo

Aspirin showed no clear difference in total mortality compared with placebo (low certainty).

• Antiplatelet agents and anticoagulants for hypertension 2022 · Cochrane Headline outcomes only
  OR 0.97 [0.87, 1.08]
  3 studies · 35794 participants
  Low

Lower blood pressure targets vs standard blood pressure targets

Lower blood pressure targets showed no clear difference in total mortality compared with standard blood pressure targets (moderate certainty).

• Blood pressure targets for the treatment of people with hypertension and cardiovascular disease 2022 · Cochrane Headline outcomes only
  RR 1.05 [0.91, 1.23]
  7 studies · 9595 participants
  Moderate

Orlistat vs placebo

• Long‐term effects of weight‐reducing drugs in people with hypertension 2021 · Cochrane Headline outcomes only
  no estimate extracted
  3 studies · 1488 participants
  Low

Naltrexone/bupropion vs placebo

Naltrexone/bupropion showed no clear difference in total mortality compared with placebo (moderate certainty).

• Long‐term effects of weight‐reducing drugs in people with hypertension 2021 · Cochrane Headline outcomes only
  RR 0.99 [0.7, 1.4]
  1 study · 8283 participants
  Moderate

Phentermine/topiramate vs placebo

• Long‐term effects of weight‐reducing drugs in people with hypertension 2021 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 1305 participants
  Low

Weight‐reducing diets vs no weight‐reducing diets

• Long‐term effects of weight‐reducing diets in people with hypertension 2021 · Cochrane Headline outcomes only
  no estimate extracted
  3 studies · 845 participants
  Very low

Lower blood pressure targets vs standard blood pressure targets

Lower BP target showed no clear difference in total mortality compared with standard BP target (high certainty).

• Blood pressure targets in adults with hypertension 2020 · Cochrane Headline outcomes only
  RR 0.95 [0.86, 1.05]
  Studies not reported
  High

Combination therapy vs monotherapy

It is very uncertain whether combination therapy changes total mortality compared with monotherapy (very low certainty).

• First‐line combination therapy versus first‐line monotherapy for primary hypertension 2020 · Cochrane Headline outcomes only
  RR 1.35 [0.08, 21.72]
  3 studies · 568 participants
  Very low

Combination with potassium‐sparing diuretics vs monotherapy

It is very uncertain whether combination with potassium‐sparing diuretics changes total mortality compared with monotherapy (very low certainty).

• First‐line combination therapy versus first‐line monotherapy for primary hypertension 2020 · Cochrane Headline outcomes only
  RR 0.24 [0.01, 5.87]
  1 study · 200 participants
  Very low

First‐line low‐dose thiazide vs placebo

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  no estimate extracted
  8 studies · 19874 participants
  High

First‐line beta‐blocker vs placebo

First‐line beta‐blocker showed no clear difference in total mortality compared with placebo (moderate certainty).

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  RR 0.96 [0.86, 1.07]
  5 studies · 19313 participants
  Moderate

First‐line angiotensin converting enzyme inhibitor vs placebo

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

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  RR 0.83 [0.72, 0.95]
  3 studies · 6002 participants
  Moderate

First‐line calcium channel blocker vs placebo

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

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  RR 0.86 [0.68, 1.09]
  1 study · 4695 participants
  Low

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

Beta‐blockers vs placebo

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

• Beta‐blockers for hypertension 2017 · Cochrane Headline outcomes only
  RR 0.99 [0.88, 1.11]
  4 studies · 23613 participants
  Moderate

Beta‐blockers vs calcium channel blockers

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

• Beta‐blockers for hypertension 2017 · Cochrane Headline outcomes only
  RR 1.07 [1, 1.14]
  4 studies · 44825 participants
  Moderate

Beta‐blockers vs renin‐angiotensin system inhibitors

Beta‐blockers showed no clear difference in total mortality compared with renin‐angiotensin system inhibitors (moderate certainty).

• Beta‐blockers for hypertension 2017 · Cochrane Headline outcomes only
  RR 1.1 [0.98, 1.24]
  3 studies · 10828 participants
  Moderate

Beta‐blockers vs diuretics

Beta‐blockers showed no clear difference in total mortality compared with diuretics (moderate certainty).

• Beta‐blockers for hypertension 2017 · Cochrane Headline outcomes only
  RR 1.04 [0.91, 1.19]
  5 studies · 18241 participants
  Moderate

Angiotensin‐converting enzyme inhibitors vs ARB

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

• Angiotensin converting enzyme (ACE) inhibitors versus angiotensin receptor blockers for primary hypertension 2014 · Cochrane Headline outcomes only
  RR 0.98 [0.88, 1.1]
  5 studies · 10248 participants
  Moderate

Intervention not reported

The intervention showed no clear difference in total mortality Systolic targets (low certainty).

• Blood pressure targets for hypertension in people with diabetes mellitus 2013 · Cochrane Headline outcomes only
  RR 1.05 [0.84, 1.3]
  1 study · 4734 participants
  Low