A recent study from Columbia University has raised important questions about the way doctors treat high blood pressure. The study suggests that one of the most commonly prescribed types of medicine—ACE inhibitors—may not work as well and may cause more side effects compared to a different option called thiazide diuretics.
High blood pressure, also known as hypertension, is a major health issue that can lead to serious problems like heart attacks, strokes, and heart failure.
Doctors usually choose from five main types of medications to treat it: ACE inhibitors, thiazide diuretics, angiotensin II receptor blockers (ARBs), dihydropyridine calcium channel blockers, and non-dihydropyridine calcium channel blockers.
But deciding which one to use first isn’t always easy, because past guidelines often relied more on expert opinion than on direct comparisons between these drugs.
In this new study, researchers looked at health records and insurance claims from nearly 5 million people who had just started taking medicine for high blood pressure. They found that almost half of these patients (48%) were given ACE inhibitors first, while only 17% were started on thiazide diuretics.
What they discovered is striking: people who began treatment with thiazide diuretics had better health outcomes. Specifically, they were 15% less likely to have major heart problems, including heart attacks, strokes, and heart failure, than those who started with ACE inhibitors. That’s a meaningful difference that could affect many lives.
Thiazide diuretics, which help the body get rid of excess salt and water through urine, seem to work better as a first treatment and come with fewer problems. In contrast, ACE inhibitors were linked to more side effects—patients on these drugs were more likely to suffer from things like a constant cough or high potassium levels.
In fact, the study found that ACE inhibitors had higher rates of 19 different side effects compared to thiazide diuretics.
The lead researcher, George Hripcsak, and his team estimated that if all the patients who were given ACE inhibitors had instead been started on thiazide diuretics, about 3,100 serious heart-related events could have been prevented. That’s a strong argument for rethinking current prescribing habits.
This study, published in the medical journal The Lancet, suggests that doctors should consider making thiazide diuretics the first choice for treating high blood pressure. These drugs are not only effective at lowering blood pressure but also seem to do a better job of protecting the heart and causing fewer side effects.
In conclusion, while ACE inhibitors have been widely used and trusted for many years, this new research points to thiazide diuretics as a safer and more effective starting point for many patients. It highlights the importance of using up-to-date scientific data to guide treatment choices, helping doctors give their patients the best possible care.
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