A new study from Columbia University suggests that one of the most commonly prescribed drugs for high blood pressure—ACE inhibitors—may not be the best option for many patients.
Instead, the study found that another type of medication, called thiazide diuretics, is more effective at preventing serious heart problems and causes fewer side effects.
However, despite these benefits, thiazide diuretics are not prescribed as often as they should be.
Doctors have several options when treating high blood pressure. Common medications include:
- Thiazide diuretics – Help the kidneys remove excess salt and water to lower blood pressure.
- ACE inhibitors – Relax blood vessels, making it easier for the heart to pump blood.
- Angiotensin II receptor blockers (ARBs) – Work similarly to ACE inhibitors but with fewer side effects.
- Calcium channel blockers – Prevent blood vessels from tightening, helping blood flow more easily.
Despite having multiple options, there hasn’t been strong data to show which drug is the best choice to start with. As a result, medical guidelines have relied on expert opinions rather than large-scale studies.
Researchers analyzed health records from about 5 million patients who had just started taking medication for high blood pressure. Their goal was to compare the effectiveness and side effects of different drugs.
The results were surprising:
- Almost half (48%) of patients were prescribed ACE inhibitors as their first treatment.
- Only 17% of patients were given thiazide diuretics, even though they performed better in the study.
- Patients who started with thiazide diuretics had 15% fewer heart attacks, strokes, and cases of heart failurecompared to those who took ACE inhibitors.
- People taking ACE inhibitors were more likely to experience 19 different side effects, including kidney problems and persistent cough.
The researchers estimated that if all the patients in the study had been given thiazide diuretics instead of ACE inhibitors, about 3,100 serious heart problems—such as heart attacks—could have been prevented.
Thiazide diuretics are not a new treatment. They have been used for decades and are well known for their ability to lower blood pressure by helping the body get rid of extra salt and water.
ACE inhibitors, on the other hand, work by relaxing blood vessels. While they are effective, this new research suggests that they may not be the best first option, especially when a safer and more effective alternative exists.
The study raises an important question: Why are ACE inhibitors still the most commonly prescribed option? The researchers believe that old prescribing habits and lack of clear guidance may be the reason.
This study, led by George Hripcsak and published in The Lancet, highlights the need for doctors to reconsider their choices when prescribing blood pressure medication.
If you have high blood pressure and are taking an ACE inhibitor, it might be worth discussing with your doctor whether a thiazide diuretic would be a better option for you. Since thiazide diuretics are effective and have fewer side effects, they may be a safer long-term choice for many patients.
As research continues, this study could lead to changes in medical guidelines, ensuring that people with high blood pressure get the best possible treatment to protect their heart health.
If you care about blood pressure, please read studies about how diets could help lower high blood pressure, and 3 grams of omega-3s a day keep high blood pressure at bay.
For more health information, please see recent studies about how tea and coffee influence your risk of high blood pressure, and results showing this olive oil could reduce blood pressure in healthy people.
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