Blood pressure-lowering efficacy of antihypertensive drugs and their combinations: a systematic review and meta-analysis of randomised, double-blind, placebo-controlled trials
Abstract
BACKGROUND
We aimed to quantify the blood pressure-lowering efficacy of antihypertensive drugs and their combinations from the five major drug classes.
METHODS
We conducted a systematic review and meta-analysis of randomised, double-blind, placebo-controlled trials involving adult participants randomly assigned to receive angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, β blockers, calcium channel blockers, or diuretics. Eligibility criteria included follow-up duration between 4 weeks and 26 weeks, antihypertensive drug treatment fixed in all participants for at least 4 weeks before follow-up blood pressure assessment; and availability of clinic blood pressure for the calculation of mean difference in systolic blood pressure between treatment groups. Crossover trials with less than 2 weeks' washout between the crossover periods were excluded. Eligible studies published between database inception and Dec 31, 2022 were identified from searches of the Cochrane Central Register of Controlled Trials, MEDLINE, and Epistemonikos; searches were updated to include studies published between Jan 1, 2023, and Feb 28, 2025. The primary outcome was placebo-corrected reduction in systolic blood pressure. Blood pressure-lowering efficacy was estimated using fixed-effects meta-analyses standardised to mean baseline blood pressure across included trials. Drug regimens were categorised into low, moderate, and high intensity, corresponding to systolic blood…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 104 participants or records.
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