For those with extremely high blood pressure, or hypertension, there are many initial medication options — so many that it can be hard to know which one to use. Now, a Yale-coauthored paper in Lancet provides more information about the relative safety and effectiveness of different hypertension drugs in order to inform this critical treatment decision. The study reveals that angiotensin converting enzyme (ACE) inhibitors may not be the best choice for initial treatment.
Unprecedented in scale, the Lancet study pulled together the data of 4.9 million patients from nine institutional databases across four countries. The researchers used that data to compare the safety and effectiveness of the five classes of first-line hypertension medications, including the popular ACE inhibitors. They were looking at how well each drug prevented the three main health consequences of hypertension — heart attack, heart failure, and stroke — and to what extent each drug caused 46 unwanted side-effects.
“This is a remarkable, massive, multinational study that has provided insights that can inform patient choices about hypertension treatment,” says Dr. Harlan Krumholz, Yale cardiologist and author on the Lancet study. “What is distinctive is not only the size, but the advanced methods that optimize the trustworthiness of the results.”