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Effect of Antihypertensive Drug Classes on Stroke Prevention: A Systematic Review and Meta-Analysis

Zobair Ibn Shams1, Kazi Iffat Jahan Maya2, Syed Tasin Bin Shahid3

  • 1Department of Acute Medicine, Epsom Hospital, Epsom, GBR.

Cureus
|April 20, 2026
PubMed

Insights

No single antihypertensive drug class definitively prevents stroke better than others. Achieving a significant reduction in systolic blood pressure (SBP) is key for stroke risk reduction, not the specific drug class used.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Clinical Trials

Background:

  • Hypertension is a primary modifiable risk factor for stroke.
  • Controversy exists regarding the comparative effectiveness of different antihypertensive drug classes for stroke prevention.

Purpose of the Study:

  • To systematically compare the stroke prevention efficacy of various antihypertensive drug classes.
  • To conduct a contemporary meta-analysis of randomized controlled trials (RCTs) published since 2000.

Main Methods:

  • Systematic literature search of PubMed, Embase, CENTRAL, and Scopus following PRISMA guidelines.
  • Meta-analysis of 10 RCTs (N=180,342) comparing ACEIs, ARBs, BBs, CCBs, or diuretics.
  • Random-effects model used for data pooling; subgroup analyses performed on prevention type, baseline risk, and achieved blood pressure differences.

Main Results:

  • Overall, no statistically significant difference in stroke risk was observed among antihypertensive drug classes (RR: 0.94; 95% CI: 0.83-1.05).
  • Substantial heterogeneity (I²=65%) was noted.
  • Stroke risk reduction was significant only in studies achieving a moderate to significant systolic blood pressure (SBP) difference (>2 mmHg) (RR: 0.78; 95% CI: 0.71-0.85).

Conclusions:

  • No specific antihypertensive drug class demonstrated superiority for overall stroke prevention.
  • The degree of achieved SBP reduction, rather than the drug class, is the critical factor in stroke risk reduction.

Keywords:
antihypertensive agentscomparative effectiveness researchdrug therapymeta-analysisstroke prevention and control

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