It is the most prescribed treatment for high blood pressure. But the real effectiveness of ACE inhibitors is however called into question by a multinational study involving nearly 5 million patients. Work which shows that hypertensives treated with diuretics present less risk of cardiac and cerebrovascular accidents.
It is the most popular high blood pressure treatment. But angiotensin-converting enzyme (ACE) inhibitors would not be the most effective prescription by increasing the risk of heart attacks and strokes. ACE inhibitors block the effects of a hormone naturally produced by the kidneys called angiotensin II. By blocking the effect of angiotensin II, these inhibitors ecause blood vessels to relax, which lowers blood pressure.
In a multinational study carried out by a research center based at Columbia University and published by The Lancet and which has been conducted – this is a first – with nearly 5 million patients, i.e. around 10% of hypertensives in the world, these ACE inhibitors appear to be the first antihypertensive prescribed at 48 % patients. And studies show that more than 3,000 major cardiovascular events recorded in these patients could have been avoided if they had first been treated with a thiadizic diuretic, drugs that promote the elimination of water and salt by the kidneys and reduce the volume of liquid circulating in the arteries, thus lowering the pressure exerted on their walls.
The medical records of 5 million patients
It is by analyzing the medical records of nearly 5 million patients and taking into account thousands of different variables to eliminate confounding factors. that this study was conducted. So she brings a serious demonstration that ACE inhibitors as first-line treatment are less effective and cause more side effects than a less often prescribed alternative.
Current guidelines from the American College of Cardiology and the American Heart Association recommend starting antihypertensive therapy with any drug from different classes: thiazide diuretics, ACE inhibitors, angiotensin II receptors and dihydropyridine calcium channel blockers.
A complex algorithm to identify the effects of different treatments
Until now, the only evidence allowing doctors to choose the best class of drugs to start treatment for people with high blood pressure were clinical trials involving only a few thousand patients, most of them they are already under treatment. The study conducted by researchers at Columbia University includes patients who are starting antihypertensive treatment.
Researchers used a complex algorithm to identify the number of heart attacks, hospitalizations for heart failure, strokes and nearly 50 adverse drug reactions recorded in patients taking either antihypertensive in the first line.
15% fewer heart attacks with diuretics
And that’s how they established that patients who were first prescribed thiazide diuretics had 15% fewer heart attacks, strokes, or hospitalizations for heart failure, but also fewer side effects than patients who were had been prescribed ACE inhibitors.
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