Findings from a large, international study comprising 4.9 million people with mild hypertension suggest that thiazide and thiazide-like diuretics might be more effective and safer than other first-line antihypertensive drugs. However, the study was not randomized, and the findings might be explained by a phenomenon known as ‘confounding by indication’.
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S.E.K. has received lecture honoraria from Merck KGaA, Merck & Co., Sanofi and Takeda, and consulting honoraria from Takeda. I.O. declares no competing interests.
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Kjeldsen, S.E., Os, I. Assessing hypertension therapies: randomization or confounding by indication?. Nat Rev Cardiol 17, 73–74 (2020). https://doi.org/10.1038/s41569-019-0313-z