A new study from Columbia University has raised important questions about how doctors treat high blood pressure, a condition that affects millions of people and can lead to serious health problems like heart attacks, strokes, and heart failure.
For years, the go-to treatment for high blood pressure has often been a type of medication called an ACE inhibitor. But this new research suggests that a different medicine might actually work better—and with fewer side effects.
When doctors treat high blood pressure, they have five main types of medications to choose from. These include thiazide diuretics, ACE inhibitors, angiotensin II receptor blockers (ARBs), and two kinds of calcium channel blockers.
Choosing which one to use first has always been a bit uncertain. Most guidelines are based on expert opinions rather than clear, direct comparisons between the different medications.
To help settle the question, researchers from Columbia University looked at health records and insurance claims from nearly 5 million people who started treatment for high blood pressure. They wanted to know which medication led to the best outcomes.
The results were surprising. Even though ACE inhibitors were the most commonly prescribed first treatment—given to nearly half of the patients—people who started with thiazide diuretics actually did better.
Those who began treatment with thiazide diuretics had 15% fewer major heart-related problems, such as heart attacks, strokes, and heart failure, compared to those who started with ACE inhibitors. On top of that, thiazide diuretics caused fewer side effects.
The study found that patients on ACE inhibitors were more likely to experience 19 different types of side effects, ranging from coughs and dizziness to more serious issues.
The researchers even estimated that if all the people who had started with ACE inhibitors had instead taken thiazide diuretics, around 3,100 serious heart-related events might have been avoided. That’s a major difference that could improve many lives.
This study, led by George Hripcsak and published in The Lancet, could lead to a big change in how high blood pressure is treated. It challenges the current habits of doctors and suggests that thiazide diuretics might be the better first choice for most patients—not only because they work well, but also because they are safer in many cases.
For people living with high blood pressure, this research is worth knowing about. It shows that the type of medication you start with can make a big difference.
If you’re currently taking blood pressure medicine—or about to start—it might be a good idea to talk to your doctor about the options. As always, never stop or change your medication without medical advice, but understanding new research can help you take part in decisions about your own health.
If you care about blood pressure, please read studies about unhealthy habits that could increase high blood pressure risk, and people with severe high blood pressure should reduce coffee intake.
For more information about blood pressure, please see recent studies that early time-restricted eating could help improve blood pressure, and results showing plant-based foods could benefit people with high blood pressure.
Copyright © 2025 Knowridge Science Report. All rights reserved.
