Millions of people around the world take medicine every day to control high blood pressure. Doctors have long used several different types of drugs to lower blood pressure and reduce the risk of heart attacks, strokes, and heart failure.
But a large new study from Columbia University is now raising important questions about which medicine should be used first when people begin treatment.
The research suggests that one of the most commonly prescribed groups of blood pressure medicines, called ACE inhibitors, may not be the best first option for many patients. Instead, an older and cheaper type of medicine called thiazide diuretics may work better and may also cause fewer side effects.
High blood pressure, also called hypertension, is one of the biggest health problems in the world. Many people do not even know they have it because it often causes no symptoms at first.
Over time, however, high blood pressure can quietly damage blood vessels and put extra pressure on the heart. This can increase the risk of serious problems such as heart attacks, strokes, kidney disease, and heart failure.
Because high blood pressure is so common, millions of people rely on daily medicine to keep it under control. Doctors can choose from several major groups of medicines. These include ACE inhibitors, angiotensin II receptor blockers, often called ARBs, calcium channel blockers, and thiazide diuretics.
For many years, doctors have commonly chosen ACE inhibitors as the first treatment. These drugs help relax blood vessels so blood can flow more easily. Some well-known ACE inhibitors include lisinopril and enalapril. They are widely used around the world and are often seen as a standard first choice for treating high blood pressure.
Thiazide diuretics work differently. They help the body remove extra salt and water through urine. This lowers the amount of fluid in the blood vessels and helps reduce blood pressure. These medicines have been around for decades and are usually inexpensive.
Even though doctors have used these medicines for many years, there has been surprisingly little strong evidence showing which type should truly be the best first treatment for patients who are just beginning blood pressure therapy.
Many medical guidelines have relied heavily on expert opinion rather than very large real-world studies.
To better understand the issue, researchers examined medical records from around 5 million patients who had recently started taking blood pressure medicine for the first time. The team compared how patients responded to different medicines and looked for major heart problems and medication side effects.
The results surprised many researchers.
The study found that nearly half of the patients, about 48%, started treatment with ACE inhibitors. Only 17% started with thiazide diuretics. However, the people who began treatment with thiazide diuretics generally had better results.
Patients who started with thiazide diuretics had about 15% fewer serious heart-related problems compared to people who started with ACE inhibitors. These problems included heart attacks, strokes, and heart failure.
The researchers also discovered that ACE inhibitors were linked to more side effects. Patients taking ACE inhibitors had higher rates of 19 different side effects compared with those taking thiazide diuretics. Some of these problems included kidney complications and long-lasting coughs, which are known side effects of ACE inhibitors.
The researchers estimated that if all the patients in the study had started with thiazide diuretics instead of ACE inhibitors, more than 3,100 major heart-related events could have been prevented.
The findings are important because ACE inhibitors are extremely common in everyday medical care. Many doctors may prescribe them simply because they are familiar with them or because they have become a long-standing habit in treatment.
The researchers believe the new evidence shows it may be time for doctors to rethink this approach.
The study was led by George Hripcsak and his research team. They hope the findings will encourage doctors and health experts to review current treatment guidelines and consider whether thiazide diuretics should become the preferred starting treatment for many patients with high blood pressure.
The researchers also pointed out that both types of medicines can still help patients lower blood pressure. Some people may respond better to one drug than another depending on their health conditions, age, or other medical needs. Patients should never stop taking prescribed medicine without speaking to their doctor first.
Still, the study provides strong evidence that the choice of first treatment can make a real difference. Since high blood pressure affects huge numbers of people worldwide, even small improvements in treatment could prevent thousands of heart attacks and strokes every year.
The findings were published in the medical journal The Lancet, one of the world’s leading medical journals. The study may influence future blood pressure treatment recommendations and could eventually change the way doctors around the world treat hypertension.
The research is also a reminder that older medicines are not always worse than newer or more popular drugs. In some cases, long-used treatments may actually provide safer and more effective care.
As scientists continue studying real-world patient data, doctors may gain a clearer understanding of which treatments truly offer the best results for patients.
If you care about high blood pressure, please read studies about breakfast for better blood pressure management, and the gut feeling that lowers blood pressure.
For more health information, please see recent studies about how the dash diet helps lower blood pressure, and how to eat your way to healthy blood pressure.
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