A new study from Columbia University has found that many doctors might not be choosing the best medicine for treating high blood pressure.
The research looked at different kinds of blood pressure drugs and found that one of the most commonly prescribed types—ACE inhibitors—may not actually be the best option for most patients. Instead, another group of medicines called thiazide diuretics seems to work better and cause fewer side effects.
Doctors have several types of drugs they can use to treat high blood pressure. Some of the main ones include thiazide diuretics, which help the body get rid of extra salt and water; ACE inhibitors, which help relax the blood vessels; angiotensin II receptor blockers (ARBs); and calcium channel blockers, which also help lower blood pressure in different ways.
Right now, there is no single rule about which drug doctors should prescribe first. Many medical guidelines are based more on expert opinion than on large, strong studies. As a result, doctors often rely on old habits rather than hard scientific proof when deciding which drug to use.
This study aimed to change that. Researchers analyzed data from about 5 million patients who had just started taking medicine for high blood pressure. They wanted to see which drugs led to better results over time and which ones caused fewer problems.
The results were surprising. Almost half of the patients—48%—were started on ACE inhibitors. Only 17% were given thiazide diuretics as their first treatment. But when researchers looked at the outcomes, they found that patients who started with thiazides did much better.
These patients had 15% fewer heart attacks, strokes, and cases of heart failure compared to those who started with ACE inhibitors.
The study also found important differences when it came to side effects. ACE inhibitors were linked to 19 different types of problems, including kidney issues and a persistent cough. These side effects were much less common in people who started on thiazide diuretics.
The researchers even estimated that if every patient in the study had been given a thiazide instead of an ACE inhibitor, about 3,100 serious heart problems could have been avoided. This shows that a simple change in how doctors prescribe medicine could make a big difference in keeping people healthier.
Thiazide diuretics are not a new discovery. They have been used for decades to help control blood pressure. They work by lowering the amount of extra fluid in the body, which naturally brings down blood pressure. While ACE inhibitors are also effective at lowering blood pressure, they seem to come with more risks compared to thiazides.
This study challenges the usual habit of starting treatment with ACE inhibitors. The findings suggest that doctors should consider using thiazide diuretics more often to help patients avoid serious heart problems and unnecessary side effects.
The research, led by Dr. George Hripcsak, was published in The Lancet and highlights why it is so important to base medical decisions on strong scientific studies. If doctors start using this new information, many people with high blood pressure could get safer and more effective treatment in the years to come.
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