Effect of Calcium Channel Blockers versus Diuretics for Hypertension

BACKGROUND: Although calcium channel blockers (CCBs) are recognized as clinical first-line agents for the treatment of hypertension, their use in combination with diuretics in cardiovascular disease caused by hypertension remains controversial. METHODS: We searched the three major databases of the Cochrane Library, EMBASE, and PubMed for the terms “calcium channel blockers,” “thiazide diuretics,” “loop diuretics,” and “hypertension,” “randomized controlled trials” and “meta-analysis trials.” These terms were searched from January 1991 to October 2021. RESULTS: For the primary outcome, in 5 studies including 35,057 patients, there was no statistically significant difference in all-cause mortality with calcium channel blockers compared with diuretics (RR = 0.98, 95% CI 0.92–1.04, I(2) = 0). In four studies including 33,643 patients with major cardiovascular events, there was no statistically significant difference in major cardiovascular events with calcium channel blockers compared with diuretics (RR = 1.00, 95% CI 1.04–1.09, I(2) = 0). CONCLUSION: There is no statistically significant difference between calcium channel blockers and diuretics in terms of cardiovascular clinical prognosis in hypertensive patients, but there are positive implications for clinical guidance, which need to be fully validated in new large randomized controlled trials.