Adverse Effects and Treatment Discontinuation of Blood Pressure–Lowering Drugs and Combinations: A Network Meta-Analysis
Authors' conclusion
This meta-analysis of short-term randomized clinical trials found that adverse drug effects that led to discontinuation of BP-lowering therapy varied by drug class and regimen, with several combination therapies being better tolerated than monotherapies.
Study context
- Population
- Participants in short-term double-blind RCTs of ACE inhibitors, ARBs, β-blockers, calcium channel blockers (CCBs), thiazide/thiazide-like diuretics or combinations (mean age 54.6 years; 44% female; mean baseline blood pressure (BP) 158/100 mm Hg)
- Participants
- 159,362 participants · 716 trials
- Comparison
- BP-lowering drug classes and combinations vs placebo
- Outcome
- Treatment discontinuation due to AEs
Methodological detailsdouble-blind trials, fixed-effect network meta-analysis, follow-up 4–26 weeks
- Double-blind trials
- Fixed-effect network meta-analysis
- Follow-up 4–26 weeks
Pooled result
As reported in the abstract
Treatment discontinuation due to AEs
Each group vs placeboOdds ratio (95% CrI)
CCBsCrI; RD 1.2% (95% CrI 0.6%-2.0%)
1.43(1.23–1.67)
ACE inhibitors plus CCBsCrI; RD 1.1% (95% CrI 0.2%-2.4%)
1.46(1.13–1.87)
β-blockers plus thiazide diureticsCrI; RD 1.7% (95% CrI 0.1%-4.3%)
1.58(1.04–2.47)
ARB monotherapyCrI; RD −0.8% (95% CrI −1.3% to −0.4%)
0.73(0.61–0.86)
ARBs plus CCBsCrI; RD −1.2% (95% CrI −1.8% to −0.6%)
0.61(0.47–0.79)
Safety
Dizziness and headache
- All regimens significantly increased dizziness vs placebo
- All but CCBs significantly decreased headache vs placebo
Original publication
Adverse Effects and Treatment Discontinuation of Blood Pressure–Lowering Drugs and Combinations: A Network Meta-Analysis. JAMA. Published 23 June 2026. doi:10.
Summarised from the published abstract; every number is checked against it