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New guideline for high blood pressure without benefits for those affected
No health professional doubts that high blood pressure poses an enormous health risk. But when does it really become dangerous? In the United States, hypertension patients are advised to start treatment from lower values than here. Protection from fatal heart diseases is not achieved, however, report German researchers.
Risk factor for fatal cardiovascular diseases
High blood pressure (hypertension) is considered a widespread disease, especially in the western world. In Germany alone, around 20 to 30 million people are affected. Too high blood pressure is a significant risk factor for dangerous cardiovascular diseases such as heart attack and stroke. But where does dangerous high blood pressure begin? Health experts give different answers to this question. For example, patients in the United States are considered ill earlier than in Germany. However, German researchers are now reporting that this categorization is not necessarily of benefit to those affected.
New blood pressure guidelines
Until recently, hypertension was defined by a systolic blood pressure of over 140 mmHg or a diastolic blood pressure of more than 90 mmHg.
But lately there have been increasing voices saying that 120 instead of 140 should be the new blood pressure target.
US professional societies lowered their blood pressure guidelines last year (new 130/80 mmHg). Since then, up to 40 percent more are considered hypertension patients.
However, a German research team led by Prof. Karl-Heinz Ladwig from the Technical University of Munich (TUM) and the Helmholtz Zentrum München has come to the conclusion that a low threshold for treatment does not protect against fatal heart diseases.
Patients should be encouraged to adopt a healthier lifestyle
As the TUM reports in a communication, the guidelines of the American College of Cardiology have had an additional category for high blood pressure since 2017: "Stage 1 hypertension".
Accordingly, patients must be treated with the corresponding values (130-139 mmHg / 80-89 mmHg). The European Society of Cardiology, on the other hand, sees these values as an “increased normal blood pressure” and no urgent need for action.
"The idea behind the US guidelines is to lower high blood pressure as early as possible and to motivate patients to diagnose a disease to live healthier lives," explained Prof. Karl-Heinz Ladwig, researcher at the TUM Clinic for Psychosomatic Medicine and Psychotherapy. University hospital on the right of the Isar and at the Helmholtz Zentrum München.
Ladwig and his team have used data from almost 12,000 patients to get an idea of the situation in Germany.
"We examined how high the risk for people in the various 'blood pressure categories' of dying from cardiovascular disease and what other risk factors existed over a period of ten years," explained Seryan Atasoy, first author of the study and Epidemiologist at the Helmholtz Zentrum München and the Ludwig Maximilians University in Munich.
The results of the study were published in the "European Heart Journal".
Motivation effect is questionable
According to the information, the risk of dying from cardiovascular disease was not significantly higher in the newly created "Stage 1 Hypertension" category than with normal blood pressure.
"The motivational effect is also questionable," says Karl-Heinz Ladwig.
People with dangerous high blood pressure who are to be treated with medication according to both US and European guidelines (“Stage 2 Hypertension”) are significantly at greater risk of dying from cardiovascular disease.
“At the same time, risk factors such as smoking and lack of exercise are particularly pronounced. This shows that despite diagnosis, many do not change their lifestyle. "
While people with dangerous hypertension were generally less depressed than others, the value was significantly higher for a subset:
About half of those who took medication for the dangerous high blood pressure were found to have depressed moods.
In the case of the untreated, this was only the case for around a third.
Depression as a risk factor for cardiovascular diseases
"We assume that this is a labeling effect," said Ladwig. "If you are officially labeled" sick ", it affects mental health."
In a previous study, Ladwig and his team had shown that depression is a similarly high risk factor for fatal cardiovascular diseases as high cholesterol or obesity.
"Our data show that depression has a medium effect size within the large non-innate risk factors for cardiovascular diseases," Ladwig said in a statement at the time.
He suggested: “In high-risk patients, the diagnostic evaluation of depression as a concomitant disease should become standard. You could grasp that with simple means. "
Additional psychological pressure
"The American College of Cardiology itself has calculated that the proportion of adults diagnosed with hypertension will increase from 32 to 46 percent as a result of the new guideline," explained Karl-Heinz Ladwig.
"So 14 percent are additionally exposed to psychological pressure - without there being a significantly higher risk of developing a fatal cardiovascular disease and without the motivating effect of the diagnosis being expected."
Therefore, adopting the US guidelines in Europe would be fundamentally wrong from Ladwig's point of view. (ad)