High blood pressure is one of the most common long-term health conditions in the world. Hundreds of millions of people live with it, and many do not even know they have it.
Doctors often call high blood pressure the “silent killer” because it usually causes no obvious symptoms.
A person can feel perfectly healthy while high pressure slowly damages blood vessels, the heart, kidneys, brain, and other organs.
Without treatment, this damage can continue for many years and greatly increase the risk of heart attack, stroke, heart failure, kidney disease, and even dementia.
Blood pressure is the force created when blood pushes against the walls of the arteries. Arteries carry oxygen-rich blood from the heart to the rest of the body.
When blood pressure stays too high over a long period, the heart has to work much harder to pump blood. The extra strain can gradually weaken the heart and damage the blood vessels throughout the body.
Healthy eating, regular exercise, maintaining a healthy weight, limiting salt, avoiding smoking, reducing alcohol intake, and managing stress can all help lower blood pressure. However, lifestyle changes alone are not enough for many people.
Millions of patients need medication to keep their blood pressure under control and reduce their risk of serious health problems.
Doctors have several different types of blood pressure medicines to choose from. Two of the most commonly used groups are ACE inhibitors and thiazide diuretics.
Both have been used safely for many years and are recommended in treatment guidelines. However, doctors have long debated which medicine should be the first choice for someone who is starting treatment.
A major new study led by researchers at Columbia University has provided important new evidence that may help answer this question. The research compared the effectiveness and safety of ACE inhibitors with thiazide diuretics in people beginning treatment for high blood pressure.
Thiazide diuretics are often called “water pills.” They help the kidneys remove extra salt and water from the body through urine. With less fluid circulating in the bloodstream, the pressure inside blood vessels falls, making it easier for the heart to pump blood.
ACE inhibitors lower blood pressure in a different way. They block an enzyme that normally causes blood vessels to tighten. When this enzyme is blocked, the blood vessels relax and widen, allowing blood to flow more easily and reducing blood pressure.
To compare the two treatments, the researchers analyzed medical records from nearly five million people who were starting blood pressure medication for the first time. This made it one of the largest studies ever carried out on this topic.
The researchers found that ACE inhibitors were much more commonly prescribed. Nearly half of the patients started treatment with an ACE inhibitor, while only about 17 percent received a thiazide diuretic as their first medicine.
However, the health outcomes told a different story. Patients who began treatment with thiazide diuretics generally experienced better results. They had about 15 percent fewer major cardiovascular events, including heart attacks, strokes, and heart failure, compared with patients who started with ACE inhibitors.
The study also found differences in side effects. People taking ACE inhibitors were more likely to develop a long-lasting dry cough and certain kidney-related problems. Although many patients tolerate ACE inhibitors well, these side effects can be troublesome enough for some people to stop taking the medicine.
Using their findings, the researchers estimated that if all of the patients had started treatment with thiazide diuretics instead of ACE inhibitors, approximately 3,100 serious cardiovascular events might have been prevented.
The researchers believe there are several reasons why ACE inhibitors continue to be prescribed more often. Doctors often become comfortable using medicines they know well, especially when previous studies did not clearly show that one treatment was better than another. In addition, treatment decisions must always consider each patient’s overall health.
Importantly, the study does not suggest that ACE inhibitors should no longer be used. These medicines remain very valuable for many patients, particularly those with heart failure or kidney disease caused by diabetes. Instead, the findings suggest that thiazide diuretics may be the better first choice for many people who are simply beginning treatment for uncomplicated high blood pressure.
The researchers hope these findings will help improve future treatment guidelines and assist doctors in choosing the most effective medicine when patients first need blood pressure treatment. Starting with the best medication may reduce the risk of serious heart disease and improve long-term health for millions of people.
Experts also stress that patients should never stop or change their blood pressure medicine without speaking to their doctor. Every person’s medical history is different, and the most suitable treatment depends on many individual factors.
The study was led by Professor George Hripcsak and published in the medical journal The Lancet. Because of its enormous size and the large amount of patient data it included, the research provides strong evidence that may influence how high blood pressure is treated around the world in the future.
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