A large new study from Columbia University is changing how many experts think about treating high blood pressure.
The study found that a group of drugs called ACE inhibitors, which are often used first, might not be the best starting choice. Instead, an older group of drugs called thiazide diuretics may actually work better and cause fewer side effects.
High blood pressure, also called hypertension, is a serious health problem. It increases the risk of heart attacks, strokes, and other diseases. There are different kinds of medications to treat it, such as ACE inhibitors, ARBs (angiotensin II receptor blockers), calcium channel blockers, and thiazide diuretics.
Until now, there hasn’t been enough strong evidence to clearly say which drug doctors should choose first. So, many medical guidelines are based more on expert opinion than on large research studies.
To get better answers, researchers studied the health records of about 5 million people who were just starting to take medicine for high blood pressure. They wanted to see which drugs helped the most and caused the fewest problems.
They found that nearly half the patients (48%) started with ACE inhibitors. Only 17% started with thiazide diuretics. However, the people who used thiazides had better results.
The study showed that people who began treatment with thiazide diuretics had 15% fewer serious heart problems—such as heart attacks, strokes, and heart failure—than those who started with ACE inhibitors.
They also had fewer side effects. ACE inhibitors were linked to more health problems, including kidney issues and a persistent cough. In fact, people who took ACE inhibitors had higher rates of 19 different side effects.
The researchers estimated that if everyone in the study had started with thiazide diuretics instead, about 3,100 major heart events might have been prevented.
Thiazide diuretics are not new. Doctors have used them for many years. They work by helping the body remove extra salt and water, which lowers blood pressure. ACE inhibitors lower blood pressure in a different way, by helping blood vessels relax.
Both types of medicine can be helpful, but this research shows that thiazide diuretics may be a safer and more effective first choice.
So why are ACE inhibitors still used more often? It may be because of habit or tradition—not because they are proven to be better. The lead researcher, George Hripcsak, hopes this new evidence will help doctors think more carefully about how they choose blood pressure treatments.
The findings were published in the medical journal The Lancet. They could help change future treatment guidelines. If more doctors start patients on thiazide diuretics, it could lead to fewer heart problems and fewer side effects for millions of people.
This study is a good reminder that medical decisions should always be based on the best and latest evidence. That way, patients can 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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