Comparative Impact of Thiazides vs. Dihydropyridines on Heart Failure Risk in Hypertensive Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Keywords

Thiazide; Dihydropyridines; Heart Failure; Risk; Meta-analysis; Hypertension.

Document Type

Research Article

Abstract

Background: Uncontrolled hypertension (HTN) is a progressive condition that significantly elevates the risk of heart failure (HF). The selection of antihypertensive agents plays a critical role in modulating HF risk. Thiazide diuretics and dihydropyridine calcium channel blockers (DHPs) are frequently utilized in clinical practice, yet their comparative long-term cardiovascular outcomes, particularly regarding HF incidence, remain underexplored. Methods: A systematic literature review was undertaken, drawing four key databases—MEDLINE, EMBASE, Web of Science, and Cochrane—covering the period from 1994 to October 2024. The scope was limited to randomized controlled trials (RCTs) evaluating thiazides or DHPs, with a minimum of 100 participants diagnosed with hypertension and at least one year of follow-up. Two independent reviewers conducted study selection, bias assessment, and data extraction focused on HF outcomes. Meta-analyses were performed to compute pooled risk ratios (RRs) for HF incidence across treatment arms. Results: The search identified 1,896 records, with 1,653 remaining after deduplication. Following a full-text evaluation of 403 eligible studies, 396 RCTs were excluded, resulting in seven RCTs comprising 49,709 participants for inclusion in the meta-analysis. The findings indicated a trend favouring thiazides over DHPs in mitigating HF risk. The pooled RR for HF was 0.77 (95% confidence intervals (CI): 0.70–0.84; I² = 53%; χ² p < 0.00001), achieving statistical significance in the fixed-effects model. Conclusion: The meta-analysis revealed a statistically significant reduction in HF incidence associated with thiazides compared to DHPs in hypertensive patients, highlighting potential implications for clinical decision-making. Nonetheless, additional research is warranted to validate these findings and elucidate their broader clinical relevance.

Recommended Citation

Alsanosi, Safaa M. and Alhindi, Yosra Z. (2025) "Comparative Impact of Thiazides vs. Dihydropyridines on Heart Failure Risk in Hypertensive Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials," Saudi Toxicology Journal: Vol. 2: Iss. 2, Article 7.
DOI: https://doi.org/10.70957/uqu.edu.sa/s.toxicology.s/stj.2025.2.7
Available at: https://stj.researchcommons.org/journal/vol2/iss2/7

DOI

https://doi.org/10.70957/uqu.edu.sa/s.toxicology.s/stj.2025.2.7