What do systematic reviews say?

RAS inhibitors vs CCBs

RAS inhibitors showed no clear difference in end stage renal failure compared with CCBs (low certainty).

• First‐line drugs inhibiting the renin angiotensin system versus other first‐line antihypertensive drug classes for… 2018 · Cochrane Headline outcomes only
  RR 0.88 [0.74, 1.05]
  4 studies · 19551 participants
  Low

RAS inhibitors vs thiazides

RAS inhibitors showed no clear difference in all‐cause death 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 [0.94, 1.07]
  1 study · 24309 participants
  Moderate

RAS inhibitors vs thiazides

RAS inhibitors showed no clear difference in total cardiovascular events 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 1.05 [1, 1.11]
  2 studies · 24379 participants
  Moderate

RAS inhibitors vs thiazides

RAS inhibitors probably leads to higher death or hospitalization for heart failure 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 1.19 [1.07, 1.31]
  1 study · 24309 participants
  Moderate

Angiotensin‐converting enzyme inhibitors vs placebo or no treatment

Angiotensin‐converting enzyme inhibitors (ACEIs) showed no clear difference in cardiovascular mortality (RR) compared with placebo or no treatment (moderate certainty).

• Beta‐blockers and inhibitors of the renin‐angiotensin aldosterone system for chronic heart failure with preserved… 2021 · Cochrane Headline outcomes only
  RR 0.93 [0.61, 1.42]
  2 studies · 945 participants
  Moderate

Angiotensin‐converting enzyme inhibitors vs placebo or no treatment

Angiotensin‐converting enzyme inhibitors (ACEIs) showed no clear difference in heart failure hospitalisation (RR) compared with placebo or no treatment (moderate certainty).

• Beta‐blockers and inhibitors of the renin‐angiotensin aldosterone system for chronic heart failure with preserved… 2021 · Cochrane Headline outcomes only
  RR 0.86 [0.64, 1.15]
  3 studies · 1019 participants
  Moderate

Angiotensin‐converting enzyme inhibitors vs placebo or no treatment

• Beta‐blockers and inhibitors of the renin‐angiotensin aldosterone system for chronic heart failure with preserved… 2021 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 74 participants
  Very low

Angiotensin‐converting enzyme inhibitors vs placebo or no treatment

Angiotensin‐converting enzyme inhibitors (ACEIs) showed no clear difference in all‐cause mortality (RR) compared with placebo or no treatment (moderate certainty).

• Beta‐blockers and inhibitors of the renin‐angiotensin aldosterone system for chronic heart failure with preserved… 2021 · Cochrane Headline outcomes only
  RR 1.04 [0.75, 1.45]
  5 studies · 1187 participants
  Moderate

Angiotensin‐converting enzyme inhibitors vs placebo or no treatment

• Beta‐blockers and inhibitors of the renin‐angiotensin aldosterone system for chronic heart failure with preserved… 2021 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 154 participants
  Low

Angiotensin receptor neprilysin inhibitors (ARNIs) vs usual care

Angiotensin receptor neprilysin inhibitors (ARNIs) showed no clear difference in cardiovascular mortality (RR) Median compared with usual care (moderate certainty).

• Beta‐blockers and inhibitors of the renin‐angiotensin aldosterone system for chronic heart failure with preserved… 2021 · Cochrane Headline outcomes only
  RR 0.96 [0.79, 1.15]
  1 study · 4796 participants
  Moderate

Angiotensin receptor neprilysin inhibitors (ARNIs) vs usual care

Angiotensin receptor neprilysin inhibitors (ARNIs) showed no clear difference in heart failure hospitalisation, first (RR) Range of compared with usual care (moderate certainty).

• Beta‐blockers and inhibitors of the renin‐angiotensin aldosterone system for chronic heart failure with preserved… 2021 · Cochrane Headline outcomes only
  RR 0.89 [0.8, 1]
  2 studies · 7362 participants
  Moderate

Angiotensin receptor neprilysin inhibitors (ARNIs) vs usual care

Angiotensin receptor neprilysin inhibitors (ARNIs) showed no clear difference in hyperkalaemia Range of compared with usual care (moderate certainty).

• Beta‐blockers and inhibitors of the renin‐angiotensin aldosterone system for chronic heart failure with preserved… 2021 · Cochrane Headline outcomes only
  RR 0.88 [0.77, 1.01]
  2 studies · 5054 participants
  Moderate

Angiotensin receptor neprilysin inhibitors (ARNIs) vs usual care

Angiotensin receptor neprilysin inhibitors (ARNIs) leads to lower all‐cause mortality (RR) Range of compared with usual care (high certainty).

• Beta‐blockers and inhibitors of the renin‐angiotensin aldosterone system for chronic heart failure with preserved… 2021 · Cochrane Headline outcomes only
  RR 0.97
  3 studies · 7663 participants
  High

Angiotensin receptor neprilysin inhibitors (ARNIs) vs usual care

• Beta‐blockers and inhibitors of the renin‐angiotensin aldosterone system for chronic heart failure with preserved… 2021 · Cochrane Headline outcomes only
  no estimate extracted
  118 participants
  High

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 renin‐angiotensin system inhibitors

Beta‐blockers showed no clear difference in total cardiovascular disease compared with renin‐angiotensin system inhibitors (low certainty).

• Beta‐blockers for hypertension 2017 · Cochrane Headline outcomes only
  RR 1 [0.72, 1.38]
  3 studies · 10828 participants
  Low

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

Beta‐blockers vs renin‐angiotensin system inhibitors

Beta‐blockers showed no clear difference in total coronary heart disease compared with renin‐angiotensin system inhibitors (low certainty).

• Beta‐blockers for hypertension 2017 · Cochrane Headline outcomes only
  RR 0.9 [0.76, 1.06]
  2 studies · 9951 participants
  Low

Beta‐blockers vs renin‐angiotensin system inhibitors

Beta‐blockers probably leads to higher withdrawal due to adverse effect compared with renin‐angiotensin system inhibitors (moderate certainty).

• Beta‐blockers for hypertension 2017 · Cochrane Headline outcomes only
  RR 1.41 [1.29, 1.54]
  2 studies · 9951 participants
  Moderate

Beta‐blockers vs placebo or no treatment

Beta‐blockers may leads to lower cardiovascular mortality (RR) compared with placebo or no treatment (low certainty).

• Beta‐blockers and inhibitors of the renin‐angiotensin aldosterone system for chronic heart failure with preserved… 2021 · Cochrane Headline outcomes only
  RR 0.78 [0.62, 0.99]
  3 studies · 1046 participants
  Low