This massive meta-analysis of 484 randomized, double-blind, placebo-controlled trials (104,176 participants) quantified the blood pressure–lowering effects of major antihypertensive drug classes and their combinations. It introduces a new intensity-based classification system and an online calculator to predict BP-lowering efficacy based on drug, dose, and baseline BP.Study Design:
484 trials, 104,176 participants
5 major drug classes: ACE inhibitors, ARBs, β-blockers, calcium channel blockers (CCBs), and diuretics
Focus: Placebo-corrected reduction in systolic BP (SBP)
Mean baseline BP: 154/100 mm Hg
Mean follow-up: 8.6 weeks
Key Findings Monotherapy (Standard Dose):

Average SBP reduction: 8.7 mm Hg

By class:
ACE inhibitors: 6.8 mm Hg
ARBs: 8.5 mm Hg
β-blockers: 8.9 mm Hg
CCBs: 9.5 mm Hg
Thiazide diuretics: 10.8 mm Hg


Dose Doubling:Adds ~1.5 mm Hg SBP reduction (except β-blockers, which add only ~0.5 mm Hg) Dual Therapy (Standard Dose of Each):

Average SBP reduction: 14.9 mm Hg
Dose doubling adds ~2.5 mm Hg more
Triple Therapy:
SBP reduction: Up to 22.5 mm Hg (quadruple therapy even higher in one trial)

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