High blood pressure, also called hypertension, is one of the most common health conditions in the world.
Millions of people live with it, and many do not know they have it because it often develops without obvious symptoms.
Even though people may feel perfectly well, high blood pressure can slowly damage the heart, blood vessels, kidneys, and brain. If it is not treated properly, it can greatly increase the risk of heart attacks, strokes, heart failure, and other serious health problems.
Doctors have several types of medicines that can lower blood pressure. Some of the most commonly prescribed drugs include thiazide diuretics, angiotensin-converting enzyme inhibitors, known as ACE inhibitors, angiotensin II receptor blockers, also called ARBs, and calcium channel blockers.
Although these medicines all help reduce blood pressure, experts have long debated which drug should be used first when someone begins treatment.
Current treatment guidelines are often based on expert opinion and evidence from smaller studies. Because of this, researchers at Columbia University wanted to examine the question more carefully using data from a much larger group of patients.
The research team, led by Dr. George Hripcsak, analyzed medical information from about five million people who had recently started treatment for high blood pressure. The study was published in the medical journal The Lancet. The researchers compared the health outcomes of people who began treatment with different blood pressure medications.
The findings were surprising. Nearly half of the patients in the study were initially prescribed ACE inhibitors. In comparison, only about 17 percent of patients started treatment with thiazide diuretics. However, the people who began treatment with thiazide diuretics generally had better outcomes.
The researchers found that people who started with thiazide diuretics had about 15 percent fewer major heart-related problems than those who started with ACE inhibitors. These serious health problems included heart attacks, strokes, and heart failure.
The findings suggest that the choice of the first medication may have an important effect on a person’s long-term health.
The study also showed differences in side effects. ACE inhibitors were associated with 19 different side effects, including kidney problems and persistent coughs that could last for a long time. These problems were much less common among people who took thiazide diuretics.
The researchers estimated that if everyone in the study had started treatment with thiazide diuretics instead of ACE inhibitors, around 3,100 serious heart problems might have been prevented. This finding suggests that small changes in treatment choices could potentially improve the health of many people.
Thiazide diuretics have been used for decades and are sometimes called water pills. They work by helping the kidneys remove extra salt and water from the body through urine. By reducing the amount of fluid circulating in the blood vessels, these medicines lower blood pressure and reduce the workload on the heart.
ACE inhibitors lower blood pressure in a different way. They block the production of a chemical that causes blood vessels to tighten. As a result, the blood vessels relax and widen, allowing blood to flow more easily.
Both types of medicines can effectively lower blood pressure, but this large study suggests that thiazide diuretics may provide greater overall benefits for many patients.
The researchers stressed that the study does not mean everyone taking ACE inhibitors should stop their medication. Different people have different medical needs. Some patients have other health conditions that make ACE inhibitors a better option for them. Any changes in medication should always be discussed with a doctor.
Still, the findings provide strong evidence that doctors may want to consider using thiazide diuretics more often as the first treatment for high blood pressure.
The study also highlights the importance of using large, high-quality research to guide medical decisions. As scientists continue to learn more about which treatments work best, patients may benefit from more effective therapies with fewer side effects.
Because high blood pressure is one of the leading causes of illness and death worldwide, even modest improvements in treatment could make a major difference. Choosing the most effective first medication may help prevent thousands of heart attacks, strokes, and cases of heart failure and improve the health of millions of people around the world.
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