What do systematic reviews say?

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 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