A meta-analysis of nine randomized trials involving 62,605 hypertensive patients found that calcium-channel blockers and angiotensin-converting-enzyme (ACE) inhibitors provided similar cardiovascular protection compared to diuretics and β-blockers. However, calcium-channel blockers showed greater reduction in stroke risk (13.5%, 95% CI 1.3–24.2, p=0.03) and less reduction in myocardial infarction risk (19.2%, 3.5–37.3, p=0.01). Heterogeneity in trial results was due to high cardiovascular event risks in some studies, but systolic pressure differences between groups were consistent. Meta-regression showed that achieved systolic pressure differences explained odds ratios for cardiovascular outcomes. The study emphasized the importance of blood pressure control, with all antihypertensive drugs showing similar long-term efficacy and safety. Calcium-channel blockers were particularly effective in stroke prevention, while ACE inhibitors and α-blockers did not offer additional cardiovascular benefits beyond blood pressure reduction. The findings suggest that blood pressure reduction is the key factor in cardiovascular protection, and that differences in systolic pressure between treatment groups significantly influence outcomes. The study highlights the importance of controlling systolic blood pressure to reduce cardiovascular complications.A meta-analysis of nine randomized trials involving 62,605 hypertensive patients found that calcium-channel blockers and angiotensin-converting-enzyme (ACE) inhibitors provided similar cardiovascular protection compared to diuretics and β-blockers. However, calcium-channel blockers showed greater reduction in stroke risk (13.5%, 95% CI 1.3–24.2, p=0.03) and less reduction in myocardial infarction risk (19.2%, 3.5–37.3, p=0.01). Heterogeneity in trial results was due to high cardiovascular event risks in some studies, but systolic pressure differences between groups were consistent. Meta-regression showed that achieved systolic pressure differences explained odds ratios for cardiovascular outcomes. The study emphasized the importance of blood pressure control, with all antihypertensive drugs showing similar long-term efficacy and safety. Calcium-channel blockers were particularly effective in stroke prevention, while ACE inhibitors and α-blockers did not offer additional cardiovascular benefits beyond blood pressure reduction. The findings suggest that blood pressure reduction is the key factor in cardiovascular protection, and that differences in systolic pressure between treatment groups significantly influence outcomes. The study highlights the importance of controlling systolic blood pressure to reduce cardiovascular complications.