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Am Fam Physician. 2024;109(3):209-210

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

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.

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These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

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