What do systematic reviews say?

First‐line thiazides vs ACE inhibitor

First‐line thiazides showed no clear difference in total mortality Duration: 1 to 5 years compared with first‐line ACE inhibitors (moderate certainty).

• First‐line diuretics versus other classes of antihypertensive drugs for hypertension 2023 · Cochrane Headline outcomes only
  RR 1 [0.95, 1.07]
  3 studies · 30961 participants
  Moderate

First‐line thiazides vs alpha‐blocker

First‐line thiazides showed no clear difference in total mortality Duration: 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 0.98 [0.88, 1.09]
  1 study · 24316 participants
  Moderate

First‐line thiazides vs calcium channel blockers

First‐line thiazides showed no clear difference in total mortality 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 1.02 [0.96, 1.08]
  7 studies · 35417 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
  5 studies · 18241 participants
  Moderate

Any antihypertensive drug vs placebo or no treatment

Antihypertensive drug leads to lower total mortality Mean duration of 3.8 years compared with placebo or no treatment (high certainty).

• Pharmacotherapy for hypertension in adults 60 years or older 2019 · Cochrane Headline outcomes only
  RR 0.91 [0.85, 0.97]
  13 studies · 25932 participants
  High