High blood pressure is one of the most common long-term health conditions in the world. It usually develops without causing obvious symptoms, which is why it is often called the “silent killer.”
Even when people feel perfectly well, high blood pressure can slowly damage the heart, brain, kidneys, and blood vessels over many years. If it is not treated, it greatly increases the risk of heart attacks, strokes, heart failure, kidney disease, and other serious health problems. Because of these risks, choosing the right treatment from the beginning is very important.
Doctors have several types of medicines available to lower blood pressure. These medicines reduce the strain on the heart and help prevent future health problems, but they do not all work in exactly the same way. A study from Columbia University suggests that one of the most commonly prescribed medicines may not be the best first choice for many people.
The research, published in The Lancet and led by Dr. George Hripcsak, compared the effectiveness and safety of several common blood pressure medicines. The findings suggest that many patients may achieve better results by starting treatment with a thiazide diuretic instead of an ACE inhibitor.
Thiazide diuretics have been used for decades and are often called “water pills.” They help the kidneys remove extra salt and water from the body through urine. This lowers the amount of fluid inside blood vessels, making it easier for blood to flow and reducing blood pressure. These medicines are inexpensive, widely available, and have a long history of successful use.
ACE inhibitors lower blood pressure in a different way. They block the production of a hormone that causes blood vessels to tighten. As the blood vessels relax and widen, blood can move more easily through the body.
Other commonly prescribed medicines include angiotensin II receptor blockers, also called ARBs, which work in a similar way but usually cause fewer side effects than ACE inhibitors, and calcium channel blockers, which relax blood vessels by preventing calcium from making the muscles in the vessel walls tighten.
For many years, doctors have chosen between these medicines based on clinical guidelines, personal experience, and individual patient needs. Although all of these medicines can successfully lower blood pressure, there has been limited evidence directly comparing which one should be used first in people who are beginning treatment.
To answer this important question, the Columbia University researchers analyzed health records from about five million people who had recently started taking medication for high blood pressure.
This made the study one of the largest investigations ever conducted on this topic. The researchers compared not only how well each medicine prevented major heart problems but also how often patients experienced unwanted side effects.
The results showed that nearly half of all patients, about 48%, started treatment with an ACE inhibitor, while only 17% began with a thiazide diuretic. However, patients who started with a thiazide diuretic generally had better health outcomes.
According to the study, people who began treatment with a thiazide diuretic were about 15% less likely to experience a heart attack, stroke, or heart failure than those who started with an ACE inhibitor.
They also experienced fewer side effects. Patients taking ACE inhibitors were more likely to develop problems such as a persistent dry cough, kidney-related complications, and several other unwanted effects that were observed more frequently during the study.
The researchers estimated that if every patient in the study who received an ACE inhibitor had instead started with a thiazide diuretic, approximately 3,100 serious cardiovascular events might have been prevented. Although this estimate is based on statistical modeling, it highlights the potential impact that selecting the most effective first treatment could have on public health.
The findings do not mean that ACE inhibitors are poor medicines. They remain an excellent choice for many people, especially those with certain medical conditions such as heart failure, chronic kidney disease, or diabetes, where they may provide additional benefits beyond lowering blood pressure.
Instead, the study suggests that for many people who are simply beginning treatment for uncomplicated high blood pressure, thiazide diuretics may offer a better balance between effectiveness and safety.
The researchers believe one reason ACE inhibitors continue to be prescribed so often is that doctors have become familiar with using them over many years. Medical practice sometimes changes slowly, even when new evidence becomes available. Large studies such as this one help update treatment recommendations and encourage doctors to review long-standing habits.
People who are currently taking medication for high blood pressure should not stop or change their medicine on their own.
Every patient’s health situation is different, and the most suitable treatment depends on age, medical history, kidney function, other illnesses, and possible side effects. Anyone with questions about their medication should discuss them with their doctor, who can decide whether any changes are appropriate.
This large Columbia University study provides strong evidence that the first medicine chosen to treat high blood pressure can make an important difference.
As more research becomes available, doctors may increasingly consider thiazide diuretics as the preferred starting treatment for many patients, helping reduce the number of heart attacks, strokes, and cases of heart failure while minimizing unnecessary side effects.
If you care about high blood pressure, please read studies about unhealthy habits that may increase high blood pressure risk, and drinking green tea could help lower blood pressure.
For more information about high blood pressure, please see recent studies about what to eat or to avoid for high blood pressure, and 12 foods that lower blood pressure.
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