Cochrane · systematic review · CD008161
First‐line diuretics versus other classes of antihypertensive drugs for hypertension
Reinhart, M, Puil, L, Salzwedel, DM, et al. · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library
HypertensionAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
28
current version
GRADE rated
25
No studies
3
Included studies
NR
No studies 3 · 10.7%Ungraded 0 · 0%Very low 0 · 0%Low 8 · 28.6%Moderate 17 · 60.7%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
First‐line thiazides compared with first‐line beta‐blockers for hypertension in adults
Population: adults with hypertension
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total mortality Duration: 1 to 5.8 years First‐line thiazides vs first‐line beta‐blockers | no estimate extracted | 5 studies · 18241 participants | Moderate Downgraded: risk of bias |
Total serious adverse events First‐line thiazides vs first‐line beta‐blockers | no estimate extracted | NR | No studies |
Total cardiovascular events Duration: 1 to 5.8 years First‐line thiazides vs first‐line beta‐blockers | no estimate extracted | 4 studies · 18135 participants | Moderate Downgraded: risk of bias |
Total stroke Duration: 1 to 5.8 years First‐line thiazides vs first‐line beta‐blockers | no estimate extracted | 4 studies · 18135 participants | Low Downgraded: risk of bias |
Total CHD Duration: 1 to 5.8 years First‐line thiazides vs first‐line beta‐blockers | no estimate extracted | 4 studies · 18135 participants | Low Downgraded: risk of bias |
Total congestive heart failure Duration: 3.8 years First‐line thiazides vs first‐line beta‐blockers | no estimate extracted | 1 study · 6569 participants | Low Downgraded: risk of bias |
Withdrawals due to adverse effects Duration: 1 to 5.8 years First‐line thiazides vs first‐line beta‐blockers | no estimate extracted | 5 studies · 18501 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
First‐line thiazides compared with first‐line calcium channel blockers for hypertension in adults
Population: adults with hypertension
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total mortality Duration: 1 to 5 years First‐line thiazides vs first‐line calcium channel blockers | RR 1.02 [0.96, 1.08] | 7 studies · 35417 participants | Moderate Downgraded: risk of bias |
Total serious adverse events Duration: 1.75 to 3 years First‐line thiazides vs first‐line calcium channel blockers | RR 1.09 [0.97, 1.24] | 2 studies · 7204 participants | Low Downgraded: risk of bias |
Total cardiovascular events Duration: 1 to 5 years First‐line thiazides vs first‐line calcium channel blockers | RR 0.93 [0.89, 0.98] | 6 studies · 35217 participants | Moderate Downgraded: risk of bias |
Total stroke Duration: 1 to 5 years First‐line thiazides vs first‐line calcium channel blockers | RR 1.06 [0.95, 1.18] | 6 studies · 35217 participants | Moderate Downgraded: risk of bias |
Total CHD Duration: 1 to 5 years First‐line thiazides vs first‐line calcium channel blockers | RR 1 [0.93, 1.08] | 6 studies · 35217 participants | Moderate Downgraded: risk of bias |
Total congestive heart failure Duration: 1 to 5 years First‐line thiazides vs first‐line calcium channel blockers | RR 0.74 [0.66, 0.82] | 6 studies · 35217 participants | Moderate Downgraded: risk of bias |
Withdrawals due to adverse effects Duration: 1 to 5 years First‐line thiazides vs first‐line calcium channel blockers | RR 0.81 [0.75, 0.88] | 7 studies · 33908 participants | Low Downgraded: risk of bias |
First‐line thiazides compared with first‐line ACE inhibitors for hypertension in adults
Population: adults with hypertension
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total mortality Duration: 1 to 5 years First‐line thiazides vs first‐line ACE inhibitors | RR 1 [0.95, 1.07] | 3 studies · 30961 participants | Moderate Downgraded: risk of bias |
Total serious adverse events First‐line thiazides vs first‐line ACE inhibitors | no estimate extracted | NR | No studies |
Total cardiovascular events Duration: 2.6 to 5 years First‐line thiazides vs first‐line ACE inhibitors | RR 0.97 [0.92, 1.02] | 3 studies · 30900 participants | Low Downgraded: risk of bias |
Total stroke Duration: 2.6 to 5 years First‐line thiazides vs first‐line ACE inhibitors | RR 0.89 [0.8, 0.99] | 3 studies · 30900 participants | Moderate Downgraded: risk of bias |
Total CHD Duration: 2.6 to 5 years First‐line thiazides vs first‐line ACE inhibitors | RR 1.03 [0.96, 1.12] | 3 studies · 30900 participants | Moderate Downgraded: risk of bias |
Total congestive heart failure Duration: 4 to 5 years First‐line thiazides vs first‐line ACE inhibitors | RR 0.94 [0.84, 1.04] | 2 studies · 30392 participants | Moderate Downgraded: risk of bias |
Withdrawals due to adverse effects Duration: 1 to 5 years First‐line thiazides vs first‐line ACE inhibitors | RR 0.73 [0.64, 0.84] | 3 studies · 25254 participants | Moderate Downgraded: risk of bias |
First‐line thiazides compared with first‐line alpha‐blockers for hypertension in adults
Population: adults with hypertension
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total mortality Duration: 3.2 years First‐line thiazides vs first‐line alpha‐blockers | RR 0.98 [0.88, 1.09] | 1 study · 24316 participants | Moderate Downgraded: risk of bias |
Total serious adverse events First‐line thiazides vs first‐line alpha‐blockers | no estimate extracted | NR | No studies |
Total cardiovascular events Duration: 3 to 3.2 years First‐line thiazides vs first‐line alpha‐blockers | RR 0.74 [0.69, 0.8] | 2 studies · 24396 participants | Moderate Downgraded: risk of bias |
Total stroke Duration: 3 to 3.2 years First‐line thiazides vs first‐line alpha‐blockers | RR 0.86 [0.73, 1.01] | 2 studies · 24396 participants | Moderate Downgraded: risk of bias |
Total CHD Duration: 3 to 3.2 years First‐line thiazides vs first‐line alpha‐blockers | RR 0.98 [0.86, 1.11] | 2 studies · 24396 participants | Low Downgraded: risk of bias |
Total congestive heart failure Duration: 3.2 years First‐line thiazides vs first‐line alpha‐blockers | RR 0.51 [0.45, 0.58] | 1 study · 24316 participants | Moderate Downgraded: risk of bias |
Withdrawals due to adverse effects Duration: 1 to 3.2 years First‐line thiazides vs first‐line alpha‐blockers | RR 0.7 [0.54, 0.89] | 3 studies · 24772 participants | Low Downgraded: risk of bias |