A recent study from Columbia University has revealed that the commonly prescribed first-line treatment for high blood pressure, ACE inhibitors, may not be as effective and could have more side effects compared to another less frequently prescribed option, thiazide diuretics.
Current medical guidelines suggest starting high blood pressure treatment with one of five different classes of medications: thiazide diuretics, ACE inhibitors, angiotensin II receptor blockers (ARBs), dihydropyridine calcium channel blockers, and non-dihydropyridine calcium channel blockers.
However, there is limited evidence to guide doctors on which drug class to choose first, leading most clinical guidelines to rely on expert opinion rather than solid data.
The research team analyzed health records and insurance claims from nearly 5 million patients who began treatment for high blood pressure. They found that ACE inhibitors were the first choice for 48% of these patients, while only 17% were initially prescribed thiazide diuretics.
The results showed that patients treated first with thiazide diuretics had 15% fewer incidents of heart attacks, heart failure, and strokes compared to those who started with ACE inhibitors.
Furthermore, those on ACE inhibitors experienced higher rates of 19 different side effects than those on thiazide diuretics. Patients on thiazides also reported fewer side effects overall.
The researchers estimate that approximately 3,100 major heart disease events could have been prevented among the patients who initially took ACE inhibitors if they had been treated with thiazide diuretics instead.
This significant study was conducted by George Hripcsak and his team and published in The Lancet.
The findings suggest a need to reconsider prescribing practices for high blood pressure, potentially favoring thiazide diuretics as a first-line treatment to improve patient outcomes and reduce side effects.
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