A study from Columbia University suggests that many doctors may not be choosing the best medicine for treating high blood pressure. The research looked at different types of blood pressure drugs and found that one of the most commonly prescribed options—ACE inhibitors—may not be the best choice for most patients.
Instead, a different type of medication called thiazide diuretics may work better and cause fewer side effects.
Doctors have several options when treating high blood pressure. The most common choices include:
- Thiazide diuretics, which help the body remove extra salt and water, lowering blood pressure.
- ACE inhibitors, which relax blood vessels to make it easier for blood to flow.
- Angiotensin II receptor blockers (ARBs) and calcium channel blockers, which work in different ways to lower blood pressure.
Currently, there is no single answer on which drug to prescribe first. Many medical guidelines are based on expert opinions rather than large studies, so doctors often rely on past practices rather than strong scientific evidence.
This study aimed to change that by analyzing data from about 5 million patients who had recently started blood pressure treatment. The researchers wanted to see which medications led to better results over time.
The findings were surprising. Nearly half of the patients (48%) were given ACE inhibitors as their first treatment, while only 17% were started on thiazide diuretics. But the data showed that thiazide diuretics were actually the better choice.
Patients who started with thiazides had 15% fewer heart attacks, strokes, and cases of heart failure compared to those who took ACE inhibitors.
The difference in side effects was also important. ACE inhibitors were linked to 19 different side effects, including kidney problems and a persistent cough. These issues were much less common in patients taking thiazide diuretics.
Based on the study, researchers estimated that if all patients had been prescribed thiazides instead of ACE inhibitors, about 3,100 major heart problems could have been avoided.
Thiazide diuretics are not a new discovery—they have been used for decades to control blood pressure. They work by reducing the amount of extra fluid in the body, which helps lower blood pressure naturally. ACE inhibitors, while effective, seem to come with more risks compared to thiazides.
This study challenges the common practice of prescribing ACE inhibitors as the first choice for high blood pressure. The results suggest that thiazide diuretics should be used more often to help patients avoid serious heart problems and unnecessary side effects.
The study, led by Dr. George Hripcsak, was published in The Lancet and highlights the importance of using solid research to guide medical decisions. If doctors start paying more attention to this new evidence, many people with high blood pressure could receive safer and more effective treatment in the future.
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