High blood pressure is one of the most common long-term health problems worldwide.
It often develops without noticeable symptoms, yet over time it can damage blood vessels, the heart, kidneys, and brain. Controlling it can greatly reduce the risk of heart attack, stroke, and heart failure.
Doctors can choose from several major groups of blood pressure medicines.
These include ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and thiazide diuretics. All can lower blood pressure, but they work in different ways and can cause different side effects.
Choosing the first medicine is important because many people will take blood pressure treatment for years. Yet several drug classes have traditionally been considered reasonable starting choices, leaving doctors to make decisions based on guidelines, other health conditions, and individual patient needs.
A major study led by researchers at Columbia University compared these commonly used treatments using health information from nearly 5 million patients. The research was led by Dr. George Hripcsak and published in The Lancet. Its enormous size allowed researchers to compare outcomes that would be difficult to study in a conventional clinical trial of similar scale.
The researchers found that ACE inhibitors were the most common first treatment. About 48% of patients began treatment with an ACE inhibitor, while roughly 17% started with a thiazide diuretic. This was notable because thiazides have been used to treat high blood pressure for decades.
Thiazide diuretics are sometimes called water pills. They help the kidneys remove more sodium and water, which can reduce the amount of fluid circulating through the blood vessels and lower blood pressure. ACE inhibitors lower blood pressure mainly by blocking a body system that causes blood vessels to tighten.
When the researchers compared the two approaches, thiazide diuretics performed particularly well. People who started with a thiazide had about a 15% lower risk of major cardiovascular outcomes, including heart attack, stroke, and hospitalization for heart failure, than people who started with an ACE inhibitor.
The study also found differences in side effects. ACE inhibitors were associated with higher rates of several unwanted effects compared with thiazide treatment. ACE inhibitors are already known to cause problems such as a persistent dry cough in some patients and can affect kidney function and blood potassium levels.
Based on the study population, the researchers estimated that more than 3,000 major cardiovascular events might have been avoided if patients who received ACE inhibitors had instead started with a thiazide diuretic. This estimate illustrates how a relatively small difference in risk can become important when millions of people receive treatment.
However, the findings do not mean ACE inhibitors are bad medicines or that everyone should switch to a thiazide. ACE inhibitors remain valuable treatments and may be particularly appropriate for people with certain medical conditions. Thiazide diuretics also have possible side effects, including changes in sodium, potassium, blood sugar, and uric acid.
The study was based largely on real-world health records rather than randomly assigning millions of patients to different drugs. Researchers used advanced methods to make the groups as comparable as possible, but observational research cannot remove every possible difference between patients. This is an important limitation when interpreting the results.
Still, the research highlights a gap between prescribing habits and the outcomes seen in this enormous patient population. An inexpensive medicine that has been available for decades may be an excellent first option for many people beginning hypertension treatment. The best choice, however, depends on a person’s age, other illnesses, medications, and individual risks.
The Lancet study gives doctors more evidence to consider when choosing a first blood pressure medicine.
For patients, the message is not to change medication on their own, but to understand that several effective options exist. Finding the right treatment and keeping blood pressure controlled over the long term remain the most important goals.
If you care about high blood pressure, please read studies about what to eat and to avoid for high blood pressure, and 12 foods that lower blood pressure.
For more health information, please see recent studies about the connection between potato and high blood pressure, and how to eat your way to healthy blood pressure.
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