Table 1.
Antihypertensive drug treatments versus each other in the treatment of hypertension
| Reference | Outcomes | ||
| Diuretics and beta-blockers versus calcium channel blockers, ACE inhibitors, angiotensin receptor blockers, and alpha-blockers | |||
| [17] | Mortality OR 0.98, 95% CI 0.94 to 1.0215 RCTs, 120,574 people: 4489/53,279 (8.4%) with older antihypertensive drugsv 5698/67,295 (8.5%) with newer antihypertensive drugsCardiovascular mortality OR 1.00, 95% CI 0.95 to 1.0715 RCTs, 106,138 people: 2104/50,115 (4.2%) with older antihypertensive drugs v 2349/56,023 (4.2%) with newer antihypertensive drugsStroke OR 0.98, 95% CI 0.88 to 1.0815 RCTs, 119,717 people: 2025/52,853 (3.8%) with older antihypertensive drugs v 2530/66,864 (3.8%) with newer antihypertensive drugsMI OR 1.00, 95% CI 0.95 to 1.0615 RCTs, 119,717 people: 2473/52,853 (4.6%) with older antihypertensive drugs v 3253/66,864 (4.9%) with newer antihypertensive drugsHeart failure OR 1.23, 95% CI 1.03 to 1.4715 RCTs, 112,446 people: 1529/49,236 (3%) with older antihypertensive drugs v 2672/63,210 (4%) with newer antihypertensive drugsORs represent effect of newer versus older antihypertensive drugs | ||
| Diuretics and beta-blockers versus calcium channel blockers | |||
| [17] | Mortality OR 0.98, 95% CI 0.92 to 1.039 RCTs, 67,435 people: 2367/30,520 (8%) with calcium channel blockers v 3303/36,915 (9%) with older antihypertensive drugsCardiovascular mortality OR 1.03, 95% CI 0.95 to 1.119 RCTs, 67,435 people: 1191/30,520 (3.9%) with calcium channel blockers v 1581/36,915 (4.3%) with older antihypertensive drugsStroke OR 0.92, 95% CI 0.84 to 1.019 RCTs, 67,435 people: 971/30,520 (3%) with calcium channel blockers v 1329/36,915 (4%) with older antihypertensive drugsMI OR 1.02, 95% CI 0.95 to 1.109 RCTs, 67,435 people: 1404/30,520 (4.6%) with calcium channel blockers v 1933/36,915 (5.2%) with older antihypertensive drugsHeart failure OR 1.33, 95% CI 1.22 to 1.448 RCTs, 65,101 people: 1111/29,343 (4%) with calcium channel blockers v 1215/35,758 (3%) with older antihypertensive drugsORs represent effect of calcium channel blockers versus older antihypertensive drugs | ||
| [20] | Stroke 11 RCTs, 91,893 people: OR 0.92, 95% CI 0.85 to 0.99Coronary heart disease 11 RCTs, 91,893 people: OR 1.02, 95% CI 0.96 to 1.09ORs represent effect of calcium channel blockers versus diuretics and beta-blockersAbsolute numbers not reported for either outcome | ||
| Diuretics versus calcium channel blockers | |||
| [18] | Mortality RR 1.03, 95% CI 0.98 to 1.08Cardiovascular mortality RR 0.95, 95% CI 0.87 to 1.04Stroke RR 1.02, 95% CI 0.91 to 1.14Cardiovascular events RR 0.94, 95% CI 0.89 to 1.00Coronary heart disease RR 0.89, 95% CI 0.76 to 1.01Congestive heart failure RR 0.74, 95% CI 0.67 to 0.81Absolute numbers not reported for any outcome | ||
| Beta-blockers versus calcium channel blockers | |||
| [19] | Mortality RR 1.07, 95% CI 1.00 to 1.144 RCTs, 44,825 people: 1768/22,525 (7.8%) with beta-blocker v 1637/22,300 (7.3%) with calcium channel blockerCardiovascular mortality RR 1.15, 95% CI 0.92 to 1.464 RCTs, 44,825 people: 785/22,525 (3.5%) with beta-blocker v 700/22,300 (3.1%) with calcium channel blockerStroke RR 1.24, 95% CI 1.11 to 1.403 RCTs, 44,167 people: 637/22,084 (2.9%) with beta-blocker v 512/22,083 (2.3%) with calcium channel blocker Coronary heart disease RR 1.05, 95% CI 0.96 to 1.153 RCTs, 44,167 people: 902/22,084 (4.1%) with beta-blocker v 860/22,083 (3.9%) with calcium channel blockerCardiovascular disease RR 1.18, 95% CI 1.08 to 1.292 RCTs, 19,915 people: 950/10,059 (9%) with beta-blocker v 800/9856 (8%) with calcium channel blocker | ||
| [22] | Mortality HR 0.89, 95% CI 0.81 to 0.99 738/9639 (8%) with calcium channel blocker v 820/9618 (9%) with beta-blockerCardiovascular disease mortality HR 0.76, 95% CI 0.65 to 0.90263/9639 (3%) with calcium channel blocker v 342/9618 (4%) with beta-blocker Stroke HR 0.77, 95% CI 0.66 to 0.89 327/9639 (3%) with calcium channel blocker v 422/9618 (4%) with beta-blocker Composite outcome of non-fatal MI (including silent MI) and fatal coronary heart disease HR 0.90, 95% CI 0.79 to 1.02 429/9639 (5%) with calcium channel blocker v 474/9618 (5%) with beta-blockerHeart failure HR 0.84, 95% CI 0.66 to 1.05 134/9639 (1%) with calcium channel blocker v 159/9618 (2%) with beta-blockerPopulation: 19,257 people with hypertension and 3 or more other cardiovascular risk factors, including people with known CVD (11% had a history of stroke or transient ischaemic attack and 6% had peripheral vascular disease) | ||
| Diuretics and beta-blockers versus angiotensin-converting enzyme inhibitors | |||
| [17] | Mortality OR 1.00, 95% CI 0.94 to 1.066 RCTs, 47,410 people: 2175/20,626 (10.5%) with ACE inhibitors v 3061/26,784 (11.4%) with older antihypertensive drugsCardiovascular mortality OR 1.02, 95% CI 0.94 to 1.116 RCTs, 42,272 people: 1365/19,126 (5%) with ACE inhibitors v 1539/23,146 (4%) with older antihypertensive drugsStroke OR 1.10, 95% CI 1.01 to 1.205 RCTs, 46,553 people: 994/20,195 (5%) with ACE inhibitors v 1184/26,358 (4%) with older antihypertensive drugsMI OR 0.97, 95% CI 0.90 to 1.045 RCTs, 46,553 people: 1216/20,195 (6%) with ACE inhibitors v 1805/26,358 (7%) with older antihypertensive drugsHeart failure OR 1.04, 95% CI 0.89 to 1.225 RCTs, 46,553 people: 917/20,195 (4.5%) with ACE inhibitors v 1200/26,358 (4.6%) with older antihypertensive drugsORs represent effect of ACE inhibitors versus older antihypertensive drugs | ||
| Diuretics and beta-blockers versus angiotensin-converting enzyme inhibitors | |||
| [20] | Stroke 5 RCTs, 46,553 people: OR 1.09, 95% CI 0.96 to 1.24Coronary heart disease 5 RCTs, 46,553 people: OR 0.97, 95% CI 0.90 to 1.05ORs represent effect of ACE inhibitor versus diuretics and beta-blockersAbsolute numbers not reported for either outcome | ||
| Diuretics versus angiotensin-converting enzyme inhibitors | |||
| [18] | Mortality RR 1.00, 95% CI 0.95 to 1.05Cardiovascular mortality RR 0.93, 95% CI 0.85 to 1.02Stroke RR 0.86, 95% CI 0.77 to 0.97Cardiovascular events RR 0.94, 95% CI 0.89 to 1.00Coronary heart disease RR 1.00, 95% CI 0.88 to 1.14Congestive heart failure RR 0.88, 95% CI 0.80 to 0.96Absolute numbers not reported for any outcome | ||
| Beta-blockers versus renin–angiotensin system inhibitors (ACE inhibitors or angiotensin receptor blockers) | |||
| [19] | Mortality RR 1.10, 95% CI 0.98 to 1.243 RCTs, 10,828 people: 496/5387 (9%) with beta-blocker v 455/5441 (8%) with renin–angiotensin system inhibitorCardiovascular mortality RR 1.09, 95% CI 0.92 to 1.293 RCTs, 10,828 people: 270/5387 (5.0%) with beta-blocker v 253/5441 (4.6%) with renin–angiotensin system inhibitorStroke RR 1.30, 95% CI 1.11 to 1.532 RCTs, 9951 people: 326/4946 (7%) with beta-blocker v 253/5005 (5%) with renin–angiotensin system inhibitor Coronary heart disease RR 0.90, 95% CI 0.76 to 1.062 RCTs, 9951 people: 236/4946 (4.8%) with beta-blocker v 271/5005 (5.4%) with renin–angiotensin system inhibitorCardiovascular disease RR 1.00, 95% CI 0.72 to 1.383 RCTs, 10,828 people: 675/5387 (5.0%) with beta-blocker v 625/5441 (4.6%) with renin–angiotensin system inhibitor | ||
| Diuretics and beta-blockers versus angiotensin receptor blockers | |||
| [17] | Mortality OR 0.91, 95% CI 1.81 to 1.02 (as reported in review)2 RCTs, 14,130 people: 642/7082 (9%) with alpha-blockers v 697/7048 (10%) with older antihypertensive drugsCardiovascular mortality OR 0.89, 95% CI 0.77 to 1.042 RCTs, 14,130 people: 3492/7082 (4.9%) with alpha-blockers v 386/7048 (5.4%) with older antihypertensive drugsStroke OR 0.76, 95% CI 0.65 to 0.882 RCTs, 14,130 people: 321/7082 (5%) with angiotensin receptor blockers v 424/7048 (6%) with older antihypertensive drugsMI OR 1.08, 95% CI 0.90 to 1.292 RCTs, 14,130 people: 268/7082 (3.7%) with angiotensin receptor blockers v 251/7048 (3.6%) with older antihypertensive drugs | ||
| Diuretics versus angiotensin receptor blockers | |||
| [18] | Mortality RR 1.09, 95% CI 0.96 to 1.22Cardiovascular mortality RR 1.07, 95% CI 0.85 to 1.36Stroke RR 1.20, 95% CI 0.93 to 1.55Cardiovascular events RR 1.00, 95% CI 0.85 to 1.18Coronary heart disease RR 0.83, 95% CI 0.59 to 1.16Congestive heart failure RR 0.88, 95% CI 0.66 to 1.16Absolute numbers not reported for any outcome | ||
| Diuretics and beta-blockers versus alpha-blockers | |||
| [17] | Mortality1 RCT, 24,335 people: 514/9067 (5.7%) with alpha-blockers v 851/15,268 (5.6%) with older antihypertensive drugsStroke1 RCT, 24,335 people: 244/9067 (3%) with alpha-blockers v 251/15,268 (2%) with older antihypertensive drugsMI1 RCT, 24,335 people: 365/9067 (4.0%) with alpha-blockers v 608/15,268 (3.9%) with older antihypertensive drugsHeart failure1 RCT, 24,335 people: 491/9067 (5%) with alpha-blockers v 420/15,268 (3%) with older antihypertensive drugsOR and CI displayed graphically for all outcomes | ||
| Diuretics versus alpha-blockers | |||
| [18] | Mortality RR 0.98, 95% CI 0.88 to 1.10Cardiovascular mortality RR 1.00, 95% CI 0.75 to 1.34Stroke RR 0.85, 95% CI 0.66 to 1.10Cardiovascular events RR 0.84, 95% CI 0.75 to 0.93Coronary heart disease RR 0.99, 95% CI 0.75 to 1.31Congestive heart failure RR 0.51, 95% CI 0.43 to 0.60Absolute numbers not reported for any outcome | ||
| Beta-blockers versus diuretics | |||
| [18] | Mortality RR 0.99, 95% CI 0.91 to 1.07Cardiovascular mortality RR 0.93, 95% CI 0.81 to 1.07Stroke RR 0.90, 95% CI 0.76 to 1.06Cardiovascular events RR 0.89, 95% CI 0.80 to 0.98Coronary heart disease RR 0.87, 95% CI 0.74 to 1.03Congestive heart failure RR 0.83, 95% CI 0.68 to 1.01RRs represent effect of diuretics versus beta-blockersAbsolute numbers not reported for any outcome | ||
| [19] | Mortality RR 1.04, 95% CI 0.91 to 1.195 RCTs, 18,241 people: 388/9195 (4.2%) with beta-blocker v 367/9046 (4.1%) with diureticCardiovascular mortality RR 1.09, 95% CI 0.90 to 1.323 RCTs, 17,452 people: 217/8802 (2.5%) with beta-blocker v 195/8650 (2.3%) with diureticStroke RR 1.17, 95% CI 0.65 to 2.094 RCTs, 18,135 people: 130/9142 (1.4%) with beta-blocker v 108/8993 (1.2%) with diureticCoronary heart disease RR 1.12, 95% CI 0.82 to 1.544 RCTs, 18,135 people: 323/9142 (3.5%) with beta-blocker v 294/8993 (3.3%) with diureticCardiovascular disease RR 1.13, 95% CI 0.99 to 1.284 RCTs, 18,135 people: 469/9142 (5.1%) with beta-blocker v 409/8993 (4.5%) with diuretic | ||
| Angiotensin receptor blockers versus calcium channel blockers | |||
| [23] | First cardiac event HR 1.04, 95% CI 0.94 to 1.15810/7649 (10.6%) with valsartan v 789/7596 (10.4%) with amlodipineMI HR 1.19, 95% CI 1.02 to 1.38369/7649 (5%) with valsartan v 313/7596 (4%) with amlodipineStroke HR 1.15, 95% CI 0.98 to 1.35322/7649 (4.2%) with valsartan v 281/7596 (3.7%) with amlodipineCongestive heart failure HR 0.89, 95% CI 0.77 to 1.03354/7649 (4.6%) with valsartan v 400/7596 (5.3%) with amlodipine | ||