ACE inhibitors such as Benazepril (Lotensin) and Captopril are commonly prescribed to treat blood pressure.
These work by relaxing and widening the blood vessels.
However, a study suggests that these popular drugs are less effective than thiazide or thiazide-like diuretics.
Thiazides are diuretic drugs that are often prescribed to lower blood pressure as they help the kidneys to remove extra salt and water through urine.
Researchers analyzed the health records of 5 million patients who were on antihypertensive drugs.
They found that those who were on thiazides had 15 percent fewer hospitalizations for heart failure, heart attacks, and strokes than those on ACE inhibitors.
According to this study, if patients were started on thiazides instead of ACE inhibitors, about 3,100 major cardiovascular events, such as heart attacks and strokes, could have been avoided.
What is more, patients on ACE inhibitors experienced more side-effects than those who began with thiazide diuretics.
Researches also noticed that non-dihydropyridine calcium channel blockers treatment was the least effective of all five first-line drug classes.
The other two first-line drugs for treating hypertension are dihydropyridine calcium channel blockers and angiotensin II receptor blockers (ARBs).
First-line drugs are the first medication that doctors use to treat a disease or illness based on clinical effectiveness and fewer side-effects.
Surprisingly, 48% of hypertensive patients are treated with ACE inhibitors, whereas 17% of patients are prescribed a thiazide diuretic.
Current clinical guidelines consider all these five different drugs effective and safe but there is not enough evidence to help doctors choose which one to start with.
Dr George Hripcsak, study co-author, said:
“Randomized clinical trials demonstrate a drug’s effectiveness and safety in a highly defined patient population.
But they’re not good at making comparisons among multiple drug classes in a diverse group of patients that you would encounter in the real world.”
Unintentionally or not, journals and authors tend to publish studies that have exciting results, and researchers may even select analytical methods that are best suited to getting the results that fit their hypotheses.
It comes down to a cherry-picking exercise, which makes the results less reliable.”
About the author
Mina Dean is a Nutritionist and Food Scientist. She holds a BSc in Human Nutrition and an MSc in Food Science.
The study was published in The Lancet (Suchard et al., 2019).