What do systematic reviews say?

First‐line angiotensin converting enzyme inhibitor vs placebo

First‐line angiotensin converting enzyme inhibitor may leads to lower total stroke compared with placebo (low certainty).

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  RR 0.65 [0.52, 0.82]
  3 studies · 6002 participants
  Low

First‐line beta‐blocker vs placebo

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

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  RR 0.83 [0.72, 0.97]
  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
  8 studies · 19874 participants
  High

First‐line calcium channel blocker vs placebo

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

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  RR 0.58 [0.41, 0.84]
  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

RAS inhibitors vs thiazides

RAS inhibitors probably leads to higher total stroke 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 1.14 [1.02, 1.28]
  1 study · 24309 participants
  Moderate

RAS inhibitors vs beta‐blocker

RAS inhibitors may leads to lower total stroke 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 0.75 [0.63, 0.88]
  1 study · 9193 participants
  Low

RAS inhibitors vs CCBs

RAS inhibitors probably leads to higher total stroke 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 1.19 [1.08, 1.32]
  4 studies · 34673 participants
  Moderate

Beta‐blockers vs renin‐angiotensin system inhibitors

Beta‐blockers probably leads to higher total stroke compared with renin‐angiotensin system inhibitors (moderate certainty).

• Beta‐blockers for hypertension 2017 · Cochrane Headline outcomes only
  RR 1.3 [1.11, 1.53]
  2 studies · 9951 participants
  Moderate

First‐line thiazides vs calcium channel blockers

First‐line thiazides showed no clear difference in total stroke 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 1.06 [0.95, 1.18]
  6 studies · 35217 participants
  Moderate

First‐line thiazides vs ACE inhibitor

First‐line thiazides probably leads to lower total stroke Duration: 2.6 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 0.89 [0.8, 0.99]
  3 studies · 30900 participants
  Moderate

First‐line thiazides vs alpha‐blocker

First‐line thiazides showed no clear difference in total stroke 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 0.86 [0.73, 1.01]
  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
  Low

Beta‐blockers vs calcium channel blockers

Beta‐blockers probably leads to higher total stroke compared with calcium‐channel blockers (moderate certainty).

• Beta‐blockers for hypertension 2017 · Cochrane Headline outcomes only
  RR 1.24 [1.11, 1.4]
  3 studies · 44167 participants
  Moderate

Beta‐blockers vs placebo

Beta‐blockers may leads to lower total stroke compared with placebo (low certainty).

• Beta‐blockers for hypertension 2017 · Cochrane Headline outcomes only
  RR 0.8 [0.66, 0.96]
  4 studies · 23613 participants
  Low

Beta‐blockers vs diuretics

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

• Beta‐blockers for hypertension 2017 · Cochrane Headline outcomes only
  RR 1.17 [0.65, 2.09]
  4 studies · 18135 participants
  Low