A recent study from Columbia University has raised important questions about the medications used to treat high blood pressure.
The research found that one of the most commonly prescribed drugs, ACE inhibitors, might not be the best choice for many patients.
Instead, thiazide diuretics—a different type of blood pressure medication—appear to be more effective at preventing serious heart problems and have fewer side effects. Yet, these medications are significantly underused.
Doctors have a variety of drugs to choose from when treating high blood pressure. Common options include thiazide diuretics, ACE inhibitors, angiotensin II receptor blockers (ARBs), and calcium channel blockers.
However, deciding which medication to start with isn’t straightforward. Most current medical guidelines are based on expert opinions rather than large-scale studies, leaving doctors with limited evidence to guide their choices.
To address this, researchers analyzed data from around 5 million patients who had just started taking medication for high blood pressure. They compared outcomes to determine which treatments worked best. The results were surprising.
Nearly half of the patients—about 48%—were prescribed ACE inhibitors as their first treatment. In contrast, only 17% were given thiazide diuretics, despite evidence suggesting that thiazides are safer and more effective.
The study found that patients who started with thiazide diuretics had 15% fewer heart attacks, strokes, and cases of heart failure compared to those who began treatment with ACE inhibitors.
Furthermore, patients on thiazides experienced fewer side effects. ACE inhibitors were associated with 19 different side effects, including kidney problems and persistent coughs, which were far less common with thiazides.
The researchers estimated that if all patients in the study had started with thiazide diuretics instead of ACE inhibitors, approximately 3,100 major heart-related events could have been avoided. This suggests that thiazides should be considered as a first-line treatment for high blood pressure more often than they currently are.
Thiazide diuretics have been used for decades to manage high blood pressure. They work by helping the kidneys remove extra salt and water from the body, which lowers blood pressure.
On the other hand, ACE inhibitors relax blood vessels, making it easier for the heart to pump blood. While both drugs are effective, this new research shows that thiazides may offer better overall outcomes for many patients.
This study challenges the widespread practice of prescribing ACE inhibitors as the default treatment for high blood pressure.
It suggests that doctors should rethink their approach and consider starting patients on thiazides more frequently. By doing so, they could reduce the risk of heart-related problems and minimize side effects for millions of patients.
Led by Dr. George Hripcsak, the study was published in The Lancet. It highlights the importance of using the best available evidence to guide medical decisions, ensuring that patients receive the safest and most effective treatments.
As this research gains attention, it could lead to changes in how doctors approach high blood pressure treatment, potentially improving outcomes for countless individuals worldwide.
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