A new study from Columbia University has found that many people with high blood pressure may be starting on the wrong medication. Doctors often prescribe a drug called an ACE inhibitor to lower blood pressure, but researchers say a different medicine, known as a thiazide diuretic, might actually work better—and with fewer side effects.
High blood pressure is one of the leading causes of heart disease, strokes, and kidney failure. To lower blood pressure and reduce these risks, doctors usually choose from several types of medicines.
These include thiazide diuretics, ACE inhibitors, ARBs (angiotensin II receptor blockers), and calcium channel blockers. Each works in a different way to help the heart and blood vessels.
Thiazide diuretics help the kidneys get rid of extra salt and water. This lowers the amount of fluid in the blood vessels, making it easier for blood to flow and lowering blood pressure.
ACE inhibitors relax blood vessels, also helping blood move more freely. ARBs work in a similar way to ACE inhibitors but often cause fewer side effects. Calcium channel blockers stop the blood vessels from tightening.
Until now, it wasn’t clear which drug was the best to start with. Doctors often relied on their experience or expert advice, rather than large studies comparing the drugs head-to-head.
To answer this question, researchers looked at health records from around 5 million people who had just started taking blood pressure medicine. They compared how well the drugs worked and how many side effects people had.
The results were surprising. Nearly half of the patients (48%) were started on ACE inhibitors, while only 17% were given thiazide diuretics. But the people who took thiazide diuretics had better outcomes.
They were 15% less likely to have a heart attack, stroke, or heart failure. They also had fewer side effects. People on ACE inhibitors were more likely to have problems like kidney issues and a dry cough—just two of 19 side effects seen more often with this type of drug.
The researchers estimated that if everyone in the study had started on thiazide diuretics instead of ACE inhibitors, around 3,100 serious heart problems could have been avoided.
Thiazide diuretics are not new. They’ve been used for many years and are known to be safe and affordable. ACE inhibitors are also helpful for some people, but this study suggests they might not be the best first choice for most patients.
So why do doctors still prescribe ACE inhibitors so often? The study’s authors think it may be due to old habits and a lack of updated, clear medical advice. Doctors may simply be used to choosing ACE inhibitors, especially if there hasn’t been strong research comparing all the options—until now.
This study, led by Dr. George Hripcsak and published in The Lancet, could lead to big changes in how doctors treat high blood pressure. It’s a reminder that even common practices should be re-evaluated as new data becomes available.
If you’re taking medicine for high blood pressure—especially if it’s an ACE inhibitor—it might be a good idea to talk with your doctor. A thiazide diuretic may be a safer and more effective option for you. As always, never stop or change medication without professional advice.
But being informed can help you and your doctor make the best choice for your long-term heart health.
If you care about blood pressure, please read studies about unhealthy habits that could increase high blood pressure risk, and eating eggs in a healthy diet may reduce risks of diabetes, high blood pressure.
For more information about blood pressure, please see recent studies that early time-restricted eating could help improve blood pressure, and results showing 12 foods that lower blood pressure.
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