What do systematic reviews say?

Angiotensin‐converting enzyme inhibitors vs ARB

All angiotensin converting enzyme (ACE) inhibitors leads to lower withdrawal due to adverse effects compared with all angiotensin receptor blockers (ARBs) (high certainty).

• Angiotensin converting enzyme (ACE) inhibitors versus angiotensin receptor blockers for primary hypertension 2014 · Cochrane Headline outcomes only
  RR 0.83 [0.74, 0.93]
  8 studies · 10963 participants
  High

Any antihypertensive drug vs placebo or no treatment

Antihypertensive drug may leads to higher withdrawals due to adverse effects Mean duration of 4.6 years compared with placebo or no treatment (low certainty).

• Pharmacotherapy for hypertension in adults 60 years or older 2019 · Cochrane Headline outcomes only
  RR 2.91 [2.56, 3.3]
  4 studies · 11310 participants
  Low

First‐line high‐dose thiazide vs placebo

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  no estimate extracted
  7 studies · 15170 participants
  Low

First‐line beta‐blocker vs placebo

First‐line beta‐blocker may leads to higher withdrawal due to adverse effects compared with placebo (low certainty).

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  RR 4.59 [4.11, 5.13]
  4 studies · 18565 participants
  Low

First‐line low‐dose thiazide vs placebo

• First‐line drugs for hypertension 2018 · Cochrane Headline outcomes only
  no estimate extracted
  3 studies · 8870 participants
  Low

Intervention not reported

• Blood pressure‐lowering efficacy of monotherapy with thiazide diuretics for primary hypertension 2014 · Cochrane Headline outcomes only
  no estimate extracted
  20 studies · 3698 participants
  Very low

Roselle extract vs placebo

The review found no eligible studies for this question.

• Roselle for hypertension in adults 2021 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

Combination with potassium‐sparing diuretics vs monotherapy

• First‐line combination therapy versus first‐line monotherapy for primary hypertension 2020 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 200 participants
  Very low

Combination therapy vs monotherapy

It is very uncertain whether combination therapy changes withdrawals due to adverse effects compared with monotherapy (very low certainty).

• First‐line combination therapy versus first‐line monotherapy for primary hypertension 2020 · Cochrane Headline outcomes only
  RR 0.85 [0.53, 1.35]
  3 studies · 568 participants
  Very low

Higher BP target (< 150‐160/95‐105 mmHg) vs lower BP target (< 140/90 mmHg)

Higher BP target (< 150‐160/95‐105 mmHg) showed no clear difference in withdrawals due to adverse effects compared with lower BP target (< 140/90 mmHg) (low certainty).

• Blood pressure targets for hypertension in older adults 2017 · Cochrane Headline outcomes only
  RR 0.83 [0.58, 1.19]
  2 studies · 7497 participants
  Low

Intervention not reported

• Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension 2016 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 30 participants
  GRADE not reported

Renin inhibitors vs ACE inhibitor

Renin inhibitors showed no clear difference in withdrawal due to adverse effects (WDAE) compared with ACE inhibitors (low certainty).

• Renin inhibitors versus angiotensin converting enzyme (ACE) inhibitors for primary hypertension 2020 · Cochrane Headline outcomes only
  RR 0.85 [0.68, 1.06]
  10 studies · 6008 participants
  Low

Intervention not reported

The intervention probably leads to higher withdrawals due to adverse effects 5 years (moderate certainty).

• Pharmacotherapy for mild hypertension 2012 · Cochrane Headline outcomes only
  RR 4.8 [4.14, 5.57]
  1 study · 17354 participants
  Moderate

Uric acid lowering therapies (UAR) vs placebo

Uric acid‐lowering drug showed no clear difference in adverse events (withdrawals due to side effects) compared with placebo (low certainty).

• Pharmacotherapy for hyperuricaemia in hypertensive patients 2020 · Cochrane Headline outcomes only
  RR 1.86 [0.43, 8.1]
  3 studies · 241 participants
  Low

First‐line thiazides vs calcium channel blockers

First‐line thiazides may leads to lower withdrawals due to adverse effects Duration: 1 to 5 years compared with first‐line calcium channel blockers (low certainty).

• First‐line diuretics versus other classes of antihypertensive drugs for hypertension 2023 · Cochrane Headline outcomes only
  RR 0.81 [0.75, 0.88]
  7 studies · 33908 participants
  Low

First‐line thiazides vs ACE inhibitor

First‐line thiazides probably leads to lower withdrawals due to adverse effects 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 0.73 [0.64, 0.84]
  3 studies · 25254 participants
  Moderate

First‐line thiazides vs alpha‐blocker

First‐line thiazides may leads to lower withdrawals due to adverse effects Duration: 1 to 3.2 years compared with first‐line alpha‐blockers (low certainty).

• First‐line diuretics versus other classes of antihypertensive drugs for hypertension 2023 · Cochrane Headline outcomes only
  RR 0.7 [0.54, 0.89]
  3 studies · 24772 participants
  Low

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 · 18501 participants
  Moderate

Intervention not reported

• Effect of cocoa on blood pressure 2017 · Cochrane Headline outcomes only
  no estimate extracted
  31 studies · 1514 participants
  Moderate

Lower blood pressure targets vs standard blood pressure targets

It is very uncertain whether lower blood pressure targets changes participant withdrawals due to adverse effects compared with standard blood pressure targets (very low certainty).

• Blood pressure targets for the treatment of people with hypertension and cardiovascular disease 2022 · Cochrane Headline outcomes only
  RR 8.16 [2.06, 32.28]
  3 studies · 801 participants
  Very low