Abstract
Background: Despite current local and global guidelines favoring thiazide-like diuretics (TLD), thiazide-type diuretics (TTD) are still more commonly prescribed for hypertension. Whether one treatment reduced cardiovascular event (CVE) risk compared to the other is still questionable. Objective: This meta-analysis aimed to prove the superiority of TLD over TTD. Method: The potential articles from PubMed, Cochrane, ScienceDirect, ResearchGate, and ProQuest were identified through January 2023. Studies comparing CVE outcomes between TLD and TTD treatment in hypertensive patients were included. The risk of bias was assessed using Cochrane RoB 2.0 for randomized trials and ROBINS-I for cohort studies. The pooled effect was measured by the fixed or random effect model and showed in risk ratio (RR) and the corresponding 95% confidence interval (CI). Result: In the beginning, 416 articles were identified from electronic scientific databases. After a detailed screening process, one randomized trial and four cohort studies were included. A total of 792,814 hypertensive patients who received TLD (59,386) or TTD (733,428) were involved in the analysis. The overall risk of bias is low in all studies. Pooled quantitative analysis from three studies showed similar RR of myocardial infarction (0.78 [0.55, 1.11]), heart failure (0.87 [0.67, 1.14], stroke (0.92 [0.78, 1.07]), or composite of CVEs (0.89 [0.72, 1.10]) between the two groups. Publication bias was not found. Conclusion: Patients who received TLD did not have a lower risk of CVE than patients who received TTD.
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