This study reviewed recent medical literature on treatments for high blood pressure which can also prevent heart failure.

High blood pressure (or hypertension – HTN) is a condition in which the pressure of blood circulating through the blood vessels (the arteries) is higher than normal. High blood pressure can occur for a variety of reasons, but typically when blood vessels become narrow and stiff the heart has to pump harder to push blood to distant tissues. Over a long period of time, HTN can cause heart failure (HF), where the heart is unable to pump enough blood.

Hypertension is typically treated with one or several classes of drugs. Diuretics (water pills) like hydrochlorothiazide lower the blood volume pushing on the arteries' walls by eliminating excess fluid from the body.  ACE inhibitors (such as enalapril) and angiotensin receptor blockers (ARBs, such as losartan) work by relaxing the blood vessels to lower the circulating blood volume.  Calcium channel blockers such as amlodipine (Norvasc) also relax the arteries to lower blood pressure. Beta blockers, such as atenolol (Tenormin) make the heart beat more slowly.

This study considered data from 223,313 patients treated with high blood pressure drugs in 26 trials between 1997 and 2009.  Patients either had HTN or other concurrent cardiovascular conditions.  Diuretics (like hydrochlorothiazide) were most efficient at preventing HF. ACE inhibitors/ARBs (enalapril, losartan) were also found to be effective, but to a lesser extent than diuretics. Calcium channel blockers (amlodipine) and beta blockers (atenolol) were the least effective at preventing HF. In women and elderly individuals, the differences between diuretics and ACE inhibitors/ARBs were smaller.

This large analysis found that diuretics were the most effective at preventing heart failure (HF) in patients with high blood pressure, followed by ACE inhibitors/ARBs.

This paper reports its findings as odds ratios, which is a statistical measurement. Odds ratios can sometimes differ from the actual risks encountered in clinical practice. 

If you have high blood pressure, talk to your doctor about your risk for heart failure, and whether you should be on a diuretic or an ACE inhibitor/ARB.