Eyasu MakonnenAnteneh BeleteAnatia Kifle2026-03-062026-03-062025-04-24https://etd.aau.edu.et/handle/123456789/7860Background: Cardiovascular disease (CVD), such as myocardial infarction (MI), stroke, and heart failure, are major global health concerns, with hypertension being a key risk factor. This study evaluates the efficacy and safety of three common antihypertensive drug classes—calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEi’s), and angiotensin receptor blockers (ARBs)—in preventing major cardiovascular events. These findings provide valuable information for clinicians in selecting appropriate treatment strategies for hypertensive patients who are at risk of cardiovascular complications, helping improve patient outcomes and reduce the global burden of CVD Methods: This systematic review and network meta-analysis was conducted following the PRISMA and PRISMA-NMA 2020 guidelines and registered on the PROSPERO database. Eligible studies included randomized controlled trials (RCTs) published between 2000 and 2024, with a minimum follow-up of three months, focusing on adults (≥18 years) with hypertension (BP 140/90–179/109 mmHg). Trials evaluating safety and efficacy of calcium channel blockers, angiotensin receptor blockers (ARBs), or angiotensin-converting enzyme inhibitors (ACEi’s) for cardiovascular outcomes (e.g., myocardial infarction, stroke, heart failure) were included. Studies with incomplete data or secondary hypertension were excluded. Data were sourced from PubMed, Embase, and Scopus using a detailed search strategy based on PICO criteria. Two independent reviewers screened the studies, and data were extracted using a structured format. The risk of bias was assessed using the Cochrane tool. Network meta-analysis was performed with a random-effects model using R Studio. Efficacy was measured by blood pressure reduction and cardiovascular events, while safety was assessed by adverse events (e.g., edema, syncope) observed. Results: This study evaluated the efficacy and safety of calcium channel blockers (Amlodipine), angiotensin-converting enzyme inhibitors (Enalapril, Ramipril, Lisinopril), and angiotensin receptor blockers (Losartan, Candesartan, Irbesartan, Valsartan) in hypertensive patients. Candesartan was 2.4 times more effective than Amlodipine in reducing systolic blood pressure and showed a 20% greater reduction in diastolic blood pressure. Amlodipine showed a 47% lower risk of myocardial infarction (MI) compared to Enalapril and a 62% lower risk compared to Irbesartan. However, there was no significant difference in death due to stroke and cardiovascular disorders across the drug classes. Amlodipine was associated with the lowest syncope incidence but the highest rates of edema. ARBs, particularly Valsartan, had the lowest edema incidence, while Enalapril had the smallest number of adverse events. Hospitalization rates for MI were lowest with Valsartan and Irbesartan. Conclusion: This study highlights the comparative cardiovascular efficacy and safety of calcium channel blockers (Amlodipine), angiotensin-converting enzyme inhibitors (Enalapril, Ramipril, Lisinopril), and angiotensin receptor blockers (Losartan, Candesartan, Irbesartan) in hypertensive adult patients. While ARBs were most effective in reducing blood pressure, no significant differences were found between drug classes for major cardiovascular events, like stroke, cardiovascular death, and hospitalization for heart failure. Amlodipine demonstrated the lowest incidence of myocardial infarction, while ARBs were most beneficial in reducing heart failure risk. Regarding safety, Amlodipine was associated with the lowest syncope incidence but the highest rates of edema, while Enalapril showed the smallest number of total adverse events. These findings suggest that treatment selection should be individualized based on both efficacy and safety profiles, considering patient-specific factors.enCardiovascular Efficacy and Safety of Calcium Channel BlockersAngiotensin Converting Enzyme Inhibitors and Angiotensin Receptor BlockersPatients with Primary HypertensionThesis