Summary of findings 1. First‐line thiazides compared with first‐line beta‐blockers for hypertension in adults.
| First‐line thiazides versus first‐line beta‐blockers for hypertension in adults | ||||||
| Patient or population: adults with hypertension Setting: outpatients Intervention: first‐line thiazides Comparison: first‐line beta‐blockers | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) |
Risk ratio (95% CI) |
№ of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with beta‐blockers | Risk with thiazides | |||||
| Total mortality Duration: 1 to 5.8 years |
44 per 1000 | 42 per 1000 (37 to 48) | RR 0.96 (0.84 to 1.10) | 18,241 (5 studies) | ⨁⨁⨁◯ MODERATE1 | Probably little to no difference (I2 = 22%) |
| Total serious adverse events | — | — | — | — | — | None of the studies reported this outcome |
| Total cardiovascular events Duration: 1 to 5.8 years |
54 per 1000 | 48 per 1000 | RR 0.88 (0.78 to 1.00) |
18,135 (4 studies) |
⨁⨁⨁◯ MODERATE1 | First‐line diuretics probably lower cardiovascular events (I2 = 44%) (ARR = 0.6%) |
| Total stroke Duration: 1 to 5.8 years |
14 per 1000 | 12 per 1000 (9 to 15) | RR 0.85 (0.66 to 1.09) | 18,135 (4 studies) | ⨁⨁◯◯ LOW1,2 | May be little to no difference (I2 = 73%) |
| Total CHD Duration: 1 to 5.8 years |
35 per 1000 | 32 per 1000 | RR 0.91 (0.78 to 1.07) |
18,135 (4 studies) |
⨁⨁◯◯ LOW1,2 | May be little to no difference (I2 = 67%) |
| Total congestive heart failure Duration: 3.8 years |
10 per 1000 | 7 per 1000 (4 to 12) | RR 0.69 (0.40 to 1.19) | 6569 (1 study) | ⨁⨁◯◯ LOW1,3 | May be little to no difference |
| Withdrawals due to adverse effects Duration: 1 to 5.8 years |
101 per 1000 | 79 per 1000 (0.72 to 0.86) |
RR 0.78 (0.71 to 0.85) |
18,501 (5 studies) |
⨁⨁⨁◯ MODERATE2 |
First‐line diuretics probably lower withdrawals due to adverse effects (I2 = 91%) (ARR = 2.2%) |
| *The risk in the thiazide group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CHD: coronary heart disease; CI: confidence interval; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1Downgraded one level because studies had notable levels of unclear or high risk of bias.
2Downgraded one level because of notable inconsistency between the outcomes of studies.
3Downgraded one level due to imprecision.