Several other meta-analyses have evaluated whether specific classes of antihypertensive agents offer protection against stroke beyond their BP-lowering In one of these meta-analyses evaluating differ- ent classes of agents used as first-line therapy in subjects with a baseline BP >140/90 mmHg, thiazide diuretics (RR, 0.63; channel blockers (RR, 0.58; 95% CI, 0.41 0.84) each reduced the risk of stroke compared with placebo or no treatment.236 Compared with thiazides, -blockers, ACEIs, and ARBs, cal- cium channel blockers appear to have a slightly greater effect on reducing the risk of stroke, although the effect is not seen for other cardiovascular outcomes and was of small magnitude (8% relative reduction in risk).235 One meta-analysis found that diuretic therapy was superior to ACEI therapy,230 and another found that calcium channel blockers were superior toACEIs.237 Another found that -blockers were less effective in reducing stroke risk than calcium channel blockers (RR, 1.24; 95% CI, 1.11 1.40) or inhibitors of the renin-angiotensin system Subgroup analyses from 1 major trial suggest that the benefit of diuretic therapy over ACEI therapy is especially prominent in blacks,239 and sub- group analysis from another large trial found that -blockers were significantly less effective than thiazide diuretics and ARBs at preventing stroke in those 65 years of age than in The results of a recent trial of the direct renin inhibitor aliskiren in patients with type 2 diabetes mel- litus plus chronic kidney disease or prevalent CVD did not find evidence that aliskiren reduced cardiovascular end points, In general, therefore, although the benefits of lowering BP as a means to prevent stroke are undisputed, there is no definitive evidence that any particular class of anti- hypertensive agents offers special protection against stroke in all patients. Further hypothesis-driven trials are warranted, however, to test differences in efficacy of individual agents in specific subgroups of patients. 