A recent study from Columbia University has raised important questions about the way doctors treat high blood pressure. For many years, ACE inhibitors have been a popular first choice for lowering blood pressure. However, this new research suggests that another type of medication called thiazide diuretics may actually work better and cause fewer side effects.
When doctors decide how to treat high blood pressure, they typically choose from five main types of medications:
- Thiazide diuretics
- ACE inhibitors
- Angiotensin II receptor blockers (ARBs)
- Dihydropyridine calcium channel blockers
- Non-dihydropyridine calcium channel blockers
Choosing the right medication is not always simple. Medical guidelines often depend on expert opinions instead of direct comparisons between these drugs, making it hard to know which one truly works best.
To find some answers, researchers at Columbia University looked at health records and insurance claims from nearly 5 million patients who started taking medication for high blood pressure. They discovered that almost half (48%) of these patients were given ACE inhibitors as their first treatment, while only 17% received thiazide diuretics.
The study’s findings were surprising. People who started with thiazide diuretics had better health outcomes compared to those who began with ACE inhibitors. Specifically, patients on thiazide diuretics experienced a 15% lower risk of major heart events, such as heart attacks, heart failure, and strokes.
This difference is important because it shows that thiazide diuretics could be a safer and more effective choice for many people.
Another key finding of the study was the difference in side effects. Patients who took ACE inhibitors experienced more side effects—19 different kinds, in fact.
Some of the most common ones included a persistent cough and elevated potassium levels, which can be harmful if not managed well. In contrast, people on thiazide diuretics reported fewer side effects, making them a more comfortable choice for long-term treatment.
The research team, led by George Hripcsak, estimated that if all the patients who were first given ACE inhibitors had instead started with thiazide diuretics, around 3,100 major heart-related events could have been prevented. This is a huge number that shows just how much of a difference the right choice of medication can make.
The findings were published in The Lancet, a respected medical journal, and they call for doctors to reconsider how they treat high blood pressure. Right now, ACE inhibitors are often the go-to choice, but this study suggests that thiazide diuretics might be a better first step for many people. Not only do they seem to lower the risk of serious heart problems, but they also come with fewer side effects.
This research provides clear evidence that relying on thiazide diuretics as the first line of treatment for high blood pressure could improve patient outcomes and reduce the risk of major heart events. For doctors, it may mean rethinking their approach to prescribing blood pressure medication to offer the safest and most effective care for their patients.
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