Clinical Question

Are thiazide and thiazide-like diuretics more effective than other first-line antihypertensive drug classes in reducing mortality or cardiovascular events in patients with hypertension?

Evidence-Based Answer

There is no mortality benefit in using thiazide or thiazide-like diuretics compared with other first-line antihypertensive drug classes; however, these diuretics most likely reduce cardiovascular events (number needed to treat [NNT] = 100; 95% CI, 63 to 333) and heart failure (NNT = 84; 95% CI, 66 to 125) compared with calcium channel blockers.¹ (Strength of Recommendation [SOR]: B, based on inconsistent or limited-quality patient-oriented evidence.) Thiazide and thiazide-like diuretics reduce stroke risk compared with angiotensin-converting enzyme (ACE) inhibitors (NNT = 167; 95% CI, 100 to 1,000). (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) Thiazides are associated with fewer withdrawals and drug discontinuations due to adverse effects compared with beta blockers, calcium channel blockers, ACE inhibitors, and alpha blockers.

Practice Pointers