A large new study from Columbia University is challenging the way many doctors treat high blood pressure. The research suggests that a commonly used drug group—ACE inhibitors—may not be the best first option for many patients. Instead, thiazide diuretics, an older and less frequently prescribed class of medicine, may actually work better and cause fewer side effects.
High blood pressure, or hypertension, is a major risk factor for heart attacks, strokes, and other serious health problems. There are several types of medications that doctors can use to treat it. These include ACE inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, and thiazide diuretics.
However, there has been little strong data to show which of these should be used as the first-line treatment. As a result, many current medical guidelines rely on expert opinion rather than large studies.
To find clearer answers, researchers looked at medical records from about 5 million people who had just started taking blood pressure medication. They wanted to see which drugs gave the best results for patients starting treatment for the first time.
They found that 48% of patients began with ACE inhibitors, even though these drugs were linked to more problems. Only 17% started with thiazide diuretics, despite these being linked to better outcomes.
The results showed that patients who started with thiazide diuretics had 15% fewer serious heart problems, like heart attacks, strokes, and heart failure, compared to those who started with ACE inhibitors.
They also had fewer side effects overall. In fact, people who took ACE inhibitors had higher rates of 19 different side effects—including kidney problems and persistent coughs—than those who used thiazides.
The researchers estimated that if everyone in the study had started with thiazide diuretics instead of ACE inhibitors, about 3,100 major heart-related events could have been avoided.
Thiazide diuretics are not new. They’ve been used for many years and work by helping the body get rid of extra salt and water, which lowers blood pressure. ACE inhibitors work by relaxing blood vessels, making it easier for the heart to pump blood.
While both types of drugs can be effective, this study shows that thiazide diuretics may offer more benefits and fewer risks when used as the first treatment.
So why are ACE inhibitors prescribed more often? It may be due to habit or assumptions rather than hard evidence. The study’s lead author, George Hripcsak, and his team hope their findings will encourage doctors to take a fresh look at the best way to start blood pressure treatment.
The research, published in The Lancet, could influence future treatment guidelines. If more doctors start choosing thiazide diuretics as the first step, it could lead to fewer heart problems and fewer medication-related side effects for millions of people.
This study is an important reminder that treatment decisions should be based on the latest and most reliable evidence, helping patients get the safest and most effective care possible.
If you care about high blood pressure, please read studies that early time-restricted eating could help improve blood pressure, and natural coconut sugar could help reduce blood pressure and artery stiffness.
For more health information, please see recent studies about added sugar in your diet linked to higher blood pressure, and results showing vitamin D could improve blood pressure in people with diabetes.
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