A recent study by Columbia University has revealed that ACE inhibitors, one of the most commonly prescribed medications for high blood pressure, may not be the most effective choice for many patients.
The research indicates that thiazide diuretics outperform ACE inhibitors in reducing the risk of serious heart issues while also causing fewer side effects. Despite this, thiazide diuretics are significantly underprescribed compared to ACE inhibitors.
When treating high blood pressure, doctors can choose from several classes of medications, including:
- Thiazide diuretics
- ACE inhibitors
- Angiotensin II receptor blockers (ARBs)
- Calcium channel blockers
However, there is limited large-scale data to guide which medication should be the first choice. As a result, many medical guidelines are based on expert opinion rather than robust studies.
In this new study, researchers examined health records of approximately 5 million patients who had recently started treatment for high blood pressure. The goal was to identify which medications led to the best outcomes.
The results were clear:
- Nearly 48% of patients were prescribed ACE inhibitors as their first treatment.
- Only 17% of patients were given thiazide diuretics, despite the superior results of this drug class.
The study showed that patients who started treatment with thiazide diuretics experienced 15% fewer heart attacks, strokes, and cases of heart failure compared to those who began with ACE inhibitors.
Additionally, thiazide diuretics caused fewer side effects. Patients on ACE inhibitors experienced higher rates of 19 different side effects, including kidney problems and persistent cough.
Researchers estimate that if all patients in the study had started with thiazide diuretics, approximately 3,100 major heart-related events, such as heart attacks, could have been prevented.
Thiazide diuretics, a well-established treatment for high blood pressure, lower blood pressure by helping the kidneys eliminate excess salt and water from the body.
In contrast, ACE inhibitors work by relaxing blood vessels, making it easier for the heart to pump blood. While both drug classes are effective, this study suggests that thiazide diuretics are not only safer but also more effective as a first-line treatment.
The findings challenge the current preference for prescribing ACE inhibitors as the first choice for high blood pressure. Researchers emphasize the need for doctors to reconsider their prescribing habits and prioritize thiazide diuretics when appropriate.
By adopting thiazide diuretics more widely as a first-line treatment, doctors could significantly reduce serious cardiovascular events and minimize adverse side effects for patients.
This research, led by George Hripcsak and published in The Lancet, underscores the importance of evidence-based decisions in medical practice.
Moving forward, these findings may influence future guidelines, ensuring that patients receive the safest and most effective treatment for high blood pressure.
As healthcare providers aim to improve patient outcomes, thiazide diuretics may play a central role in redefining the approach to hypertension treatment.
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