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First-line diuretics versus other classes of antihypertensive drugs for hypertension
CONCLUSIONS: When used as first-line agents for the treatment of hypertension, thiazides and thiazide-like drugs likely do not change total mortality and likely decrease some morbidity outcomes such as cardiovascular events and withdrawals due to adverse effects, when compared to beta-blockers, calcium channel blockers, ACE inhibitors, and alpha-blockers.PMID:37439548 | DOI:10.1002/14651858.CD008161.pub3
Source: Cochrane Database of Systematic Reviews - July 13, 2023 Category: General Medicine Authors: Marcia Reinhart Lorri Puil Douglas M Salzwedel James M Wright Source Type: research

Calcium channel blockers versus other classes of drugs for hypertension
CONCLUSIONS: For the treatment of hypertension, there is moderate certainty evidence that diuretics reduce major cardiovascular events and congestive heart failure more than CCBs. There is low to moderate certainty evidence that CCBs probably reduce major cardiovascular events more than beta-blockers. There is low to moderate certainty evidence that CCBs reduced stroke when compared to angiotensin-converting enzyme (ACE) inhibitors and reduced myocardial infarction when compared to angiotensin receptor blockers (ARBs), but increased congestive heart failure when compared to ACE inhibitors and ARBs. Many of the differences ...
Source: Cochrane Database of Systematic Reviews - January 9, 2022 Category: General Medicine Authors: Jiaying Zhu Ning Chen Muke Zhou Jian Guo Cairong Zhu Jie Zhou Mengmeng Ma Li He Source Type: research

First-line drugs inhibiting the renin angiotensin system versus other first-line antihypertensive drug classes for hypertension.
CONCLUSIONS: All-cause death is similar for first-line RAS inhibitors and first-line CCBs, thiazides and beta-blockers. There are, however, differences for some morbidity outcomes. First-line thiazides caused less HF and stroke than first-line RAS inhibitors. First-line CCBs increased HF but decreased stroke compared to first-line RAS inhibitors. The magnitude of the increase in HF exceeded the decrease in stroke. Low-quality evidence suggests that first-line RAS inhibitors reduced stroke and total CV events compared to first-line beta-blockers. The small differences in effect on blood pressure between the different classe...
Source: Cochrane Database of Systematic Reviews - November 14, 2018 Category: General Medicine Authors: Chen YJ, Li LJ, Tang WL, Song JY, Qiu R, Li Q, Xue H, Wright JM Tags: Cochrane Database Syst Rev Source Type: research

First-line drugs for hypertension.
CONCLUSIONS: First-line low-dose thiazides reduced all morbidity and mortality outcomes in adult patients with moderate to severe primary hypertension. First-line ACE inhibitors and calcium channel blockers may be similarly effective, but the evidence was of lower quality. First-line high-dose thiazides and first-line beta-blockers were inferior to first-line low-dose thiazides. PMID: 29667175 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - April 18, 2018 Category: General Medicine Authors: Wright JM, Musini VM, Gill R Tags: Cochrane Database Syst Rev Source Type: research

Perioperative beta-blockers for preventing surgery-related mortality and morbidity.
CONCLUSIONS: According to our findings, perioperative application of beta-blockers still plays a pivotal role in cardiac surgery, as they can substantially reduce the high burden of supraventricular and ventricular arrhythmias in the aftermath of surgery. Their influence on mortality, AMI, stroke, congestive heart failure, hypotension and bradycardia in this setting remains unclear.In non-cardiac surgery, evidence shows an association of beta-blockers with increased all-cause mortality. Data from low risk of bias trials further suggests an increase in stroke rate with the use of beta-blockers. As the quality of evidence is...
Source: Cochrane Database of Systematic Reviews - March 13, 2018 Category: General Medicine Authors: Blessberger H, Kammler J, Domanovits H, Schlager O, Wildner B, Azar D, Schillinger M, Wiesbauer F, Steinwender C Tags: Cochrane Database Syst Rev Source Type: research

Beta-blockers for hypertension.
CONCLUSIONS: Most outcome RCTs on beta-blockers as initial therapy for hypertension have high risk of bias. Atenolol was the beta-blocker most used. Current evidence suggests that initiating treatment of hypertension with beta-blockers leads to modest CVD reductions and little or no effects on mortality. These beta-blocker effects are inferior to those of other antihypertensive drugs. Further research should be of high quality and should explore whether there are differences between different subtypes of beta-blockers or whether beta-blockers have differential effects on younger and older people. PMID: 28107561 [PubMe...
Source: Cochrane Database of Systematic Reviews - January 19, 2017 Category: Journals (General) Authors: Wiysonge CS, Bradley HA, Volmink J, Mayosi BM, Opie LH Tags: Cochrane Database Syst Rev Source Type: research

Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation.
CONCLUSIONS: Several class IA, IC and III drugs, as well as class II drugs (beta-blockers), are moderately effective in maintaining sinus rhythm after conversion of atrial fibrillation. However, they increase adverse events, including pro-arrhythmia, and some of them (disopyramide, quinidine and sotalol) may increase mortality. Possible benefits on clinically relevant outcomes (stroke, embolism, heart failure) remain to be established. PMID: 25820938 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - April 2, 2015 Category: Journals (General) Authors: Lafuente-Lafuente C, Valembois L, Bergmann JF, Belmin J Tags: Cochrane Database Syst Rev Source Type: research

First-line drugs inhibiting the renin angiotensin system versus other first-line antihypertensive drug classes for hypertension.
CONCLUSIONS: We found predominantly moderate quality evidence that all-cause mortality is similar when first-line RAS inhibitors are compared to other first-line antihypertensive agents. First-line thiazides caused less HF and stroke than first-line RAS inhibitors. The quality of the evidence comparing first-line beta-blockers and first-line RAS inhibitors was low and the lower risk of total CV events and stroke seen with RAS inhibitors may change with the publication of additional trials. Compared with first-line CCBs, first-line RAS inhibitors reduced HF but increased stroke. The magnitude of the reduction in HF exceeded...
Source: Cochrane Database of Systematic Reviews - January 11, 2015 Category: Journals (General) Authors: Xue H, Lu Z, Tang WL, Pang LW, Wang GM, Wong GW, Wright JM Tags: Cochrane Database Syst Rev Source Type: research

Interventions for deliberately altering blood pressure in acute stroke.
CONCLUSIONS: There is insufficient evidence that lowering blood pressure during the acute phase of stroke improves functional outcome. It is reasonable to withhold blood pressure-lowering drugs until patients are medically and neurologically stable, and have suitable oral or enteral access, after which drugs can than be reintroduced. In people with acute stroke, CCBs, ACEI, ARA, beta blockers and NO donors each lower blood pressure while phenylephrine probably increases blood pressure. Further trials are needed to identify which people are most likely to benefit from early treatment, in particular whether treatment started...
Source: Cochrane Database of Systematic Reviews - October 28, 2014 Category: Journals (General) Authors: Bath PM, Krishnan K Tags: Cochrane Database Syst Rev Source Type: research

Beta-blockers for preventing stroke recurrence.
CONCLUSIONS: To date, no available evidence supports the routine use of beta-blockers for secondary prevention after stroke or TIA. More studies with larger samples are needed. PMID: 25317988 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - October 15, 2014 Category: Journals (General) Authors: De Lima LG, Saconato H, Atallah AN, da Silva EM Tags: Cochrane Database Syst Rev Source Type: research

Perioperative beta-blockers for preventing surgery-related mortality and morbidity.
CONCLUSIONS: According to our findings, perioperative application of beta-blockers still plays a pivotal role in cardiac surgery , as they can substantially reduce the high burden of supraventricular and ventricular arrhythmias in the aftermath of surgery. Their influence on mortality, AMI, stroke, congestive heart failure, hypotension and bradycardia in this setting remains unclear.In non-cardiac surgery, evidence from low risk of bias trials shows an increase in all-cause mortality and stroke with the use of beta-blockers. As the quality of evidence is still low to moderate, more evidence is needed before a definitive co...
Source: Cochrane Database of Systematic Reviews - September 18, 2014 Category: Journals (General) Authors: Blessberger H, Kammler J, Domanovits H, Schlager O, Wildner B, Azar D, Schillinger M, Wiesbauer F, Steinwender C Tags: Cochrane Database Syst Rev Source Type: research

Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery.
CONCLUSIONS: Prophylaxis to prevent atrial fibrillation after cardiac surgery with any of the studied pharmacological or non-pharmacological interventions may be favored because of its reduction in the rate of atrial fibrillation, decrease in the length of stay and cost of hospital treatment and a possible decrease in the rate of stroke. However, this review is limited by the quality of the available data and heterogeneity between the included studies. Selection of appropriate interventions may depend on the individual patient situation and should take into consideration adverse effects and the cost associated with each ap...
Source: Cochrane Database of Systematic Reviews - March 2, 2013 Category: Journals (General) Authors: Arsenault KA, Yusuf AM, Crystal E, Healey JS, Morillo CA, Nair GM, Whitlock RP Tags: Cochrane Database Syst Rev Source Type: research