A large new study from Columbia University has found that one of the most commonly prescribed drugs for high blood pressure, known as ACE inhibitors, might not be the best option for many people.
Instead, another group of drugs called thiazide diuretics may work better and cause fewer side effects. Even though the research shows clear benefits, these diuretics are not used as often as they could be.
Doctors have several choices when it comes to treating high blood pressure. Some of the main types of medications include ACE inhibitors, thiazide diuretics, angiotensin II receptor blockers (ARBs), and calcium channel blockers.
But doctors often don’t have clear, large-scale research to help them decide which drug to use first. As a result, many current guidelines are based more on expert opinions than solid data from real-world studies.
In this new study, researchers looked at health records from about 5 million people who had just started treatment for high blood pressure. They wanted to see which medications gave the best results in preventing serious heart problems and which ones caused the fewest side effects.
They found that nearly half of these patients—around 48%—started treatment with ACE inhibitors. Only 17% began with thiazide diuretics, even though those who took thiazides had better outcomes.
The results were striking. Patients who started with thiazide diuretics had 15% fewer major heart problems like heart attacks, strokes, and heart failure than those who began with ACE inhibitors. They also experienced fewer side effects.
In fact, the study found that people on ACE inhibitors were more likely to suffer from a range of issues—19 different side effects in total—including kidney problems and a constant cough.
The researchers calculated that if all the patients in the study had started with thiazide diuretics instead of ACE inhibitors, about 3,100 major heart-related events could have been prevented. That’s a significant number and shows how important the choice of first medication can be.
Thiazide diuretics are not new. They’ve been around for decades and are known to help the body get rid of extra salt and water through the kidneys. This lowers the amount of fluid in the blood vessels, helping to reduce blood pressure. They are also usually inexpensive and widely available.
ACE inhibitors work differently. They help relax the blood vessels, making it easier for the heart to pump blood. While they are also effective, this study shows that they may not be the best first option for many patients.
The research team, led by Dr. George Hripcsak, believes these findings should encourage doctors to rethink which drug they choose first for treating high blood pressure. With better outcomes and fewer side effects, thiazide diuretics might be a smarter starting point for many people.
The study was published in the respected medical journal The Lancet. It adds to growing evidence that health care providers should make decisions based on the best available data, not just habits or long-standing traditions.
Choosing the right medicine from the start can make a real difference in people’s lives by lowering their risk of serious illness and improving their overall health.
If you care about blood pressure, please read studies about unhealthy habits that could increase high blood pressure risk, and people with severe high blood pressure should reduce coffee intake.
For more information about blood pressure, please see recent studies that early time-restricted eating could help improve blood pressure, and results showing plant-based foods could benefit people with high blood pressure.
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