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Blood pressure instead of 140 Starting at 120 it becomes dangerous
About every third German has high blood pressure. This can have dire consequences. Hypertension increases the risk of heart attack, stroke and other dangerous diseases. So far, an upper limit of 140 mmHg has been recommended. However, according to one study, a systolic target of 120 would be better. The new recommendations unsettle many patients.
Lower blood pressure to 120 instead of 140
According to the Robert Koch Institute (RKI), about every third person in Germany has hypertension. In the age group of 70- to 79-year-olds it should even be three quarters. Increased blood pressure increases the risk of cardiovascular diseases such as coronary heart disease, congestive heart failure and stroke, as well as chronic renal insufficiency and dementia. Patients have been advised to use an upper limit of 140 mmHg. However, in November last year, a large-scale US study was published that concluded that systolic blood pressure should be reduced to 120 instead of 140 to reduce the risk of sequelae. But should it therefore be used nationwide antihypertensives? The publication of the so-called "Sprint" study certainly caused a lot of discussion. In Germany, patients were also unsettled.
120 is the new 140. Picture: Photographee.eu - fotolia As the news agency dpa reports, many Germans seek medical advice since the appearance of the investigation. "People are wondering when they will be set to 120," said Yvonne Dörffel, head of the Charité Medical Polyclinic in Berlin. Experts in Germany are divided on the extent to which the result is practicable at all.
Individual treatment of blood pressure
Physicians recently demanded in the journal "The Lancet" that in all patients with high risk of heart attack or stroke, antihypertensive drugs should be used - regardless of their blood pressure. According to scientists who evaluated 123 studies involving more than 600,000 people, the threshold of 140 for tablet treatment was too high. However, they noted that the studies were partly only partially comparable. The head of the Hypertension Center Munich, Martin Middeke, commented critically on the meta-analysis: "You can not make a mess of everything. The treatment of blood pressure is always an individual therapy. "For example, previous illnesses should also be considered.
Danger of death decreases by 13 percent
As noted by Kazem Rahimi of the George Institute for Global Health at Oxford University and his team in "The Lancet," treatment with antihypertensive drugs significantly reduces the risk of cardiovascular disease. If the systolic blood pressure is lowered by ten points, the risk for major cardiovascular events reduced by one fifth, for strokes and heart failure by a quarter and the risk of death by 13 percent. "The results are very much in favor of reducing systolic blood pressure below 130," says Rahimi. It is said that millions of lives could be saved if all high-risk patients are treated with antihypertensive drugs, no matter what the reason for their increased risk.
The guideline for drug treatment is currently around 140/90. Patients who have elevated blood pressure below this level are usually advised to change their lifestyle. In most cases high blood pressure can be defeated by a lot of sports and healthy nutrition. In addition, home remedies for hypertension may be supportive.
Study discontinued early due to positive results
Bernd Sanner, chief physician at the Agaplesion-Bethesda-Hospital Wuppertal, said that it has long been known from large studies that blood pressure is associated with an increased mortality from as early as about 115/70. "Conversely, people then asked themselves: If you try to lower excessive blood pressure, which target value makes good sense for your health?", Says the expert.
In 2010, a first major study of higher blood pressure reduction in diabetics - called "Accord" - concluded that the risk of major cardiovascular events was not significantly reduced. In the "Sprint" study, two treatment approaches were again compared with another group of subjects: Some of the patients were given an intensive therapy with a systolic blood pressure below 120 as target, the other a standard therapy, which aims at a value of 140. Overall, the researchers had investigated 9,361 people from the US and Costa Rica. All participants were older than 50 years and had a blood pressure of 130 to 180, in addition to other risk factors for cardiovascular disease such as obesity. Excluded from the study were people with diabetes mellitus or a previously-suffered stroke, the scientists reported at that time in the "New England Journal of Medicine". The five-year study was terminated prematurely in August 2015 after a good three years - because of the positive results, as it was said.
Criticism of study result
Although it was reported that with intensive therapy a good quarter fewer deaths and one third less cardiovascular events, ie heart attack, coronary syndrome, stroke or heart failure. However, the list of limitations and the side effects had been impressive. "It will be difficult to find any patients for whom intensive care could be useful," said Dörffel. The physician also sees it critically that the entry value for patients aged 68 years old was 139.
"Only one-third were people with systolic hypertension at all, the rest did not have significantly inflated baseline levels." In addition, 80 percent had no cardiovascular disease - unlike many patients in the practice. Ultimately, patients with an already low baseline of 132 would have benefited from the intensive therapy. "Those who had it had little or no benefit." In patients with existing renal insufficiency, the approach had little effect.
Decline especially in the heart rate
Dörffel explained that the common view on the study findings was that the one-third fewer cardiovascular events related mainly to strokes and heart attacks, but: "That's wrong, there's no clear difference." Rather, especially in the heart failure numbers decline , Middeke from the HZM said according to dpa, it was very surprising that a drastic reduction did not affect the stroke and heart attack number.
"Heart failure is generally a major cause of death in the tested age group - and most of the drugs used are exactly those used in heart failure," Dörffel explained. Therefore, it could be concluded that the intensive therapy prevented very threatening heart failure, but that the blood pressure setting for the reduced death rate played a minor role. "These details are unfortunately hidden in the 37 pages appendix with the exact data," said the physician.
Great differences between men and women
According to Middeke, there were also big differences between men and women. For example, the risk of cardiovascular events during intensive therapy was 28 percent lower in men, but only 16 percent in women. "So you have to look very carefully who can actually benefit from intensive therapy," said Middeke. "One can not generalize the result." In Germany, blood pressure patients would look at the doctor about every three to six months.
"With a target of 120, monthly checks will be needed because the side effects are bigger," explained Sanner. To be sure, this would be a great challenge for the already full practices. "But this effort is worth it," says the head physician. He considers it appropriate to adjust to a target of 120 in some of the over 75-year-old blood pressure patients and in people over 50 with cardiovascular risks.
"That's a relevant part, determined 30 to 40 percent of all patients." But each case must be considered and decided individually. "Since you have to be pragmatic: It does not make sense to hire someone partout to 120, if he then falls over or is no longer powerful," explained Sanner, according to dpa. It will generally be a long way to reach the new goal among all those for whom it makes sense. "At present, just over 50 percent of hypertensive patients in Germany are already set to 140."
Most Germans know about their own high blood pressure
In a Europe-wide comparison, however, this is a very good value. "Ten years ago, only one in ten people in Germany achieved the target value." In addition, the knowledge of their own value, according to an evaluation of the RKI meanwhile much better. "80 percent of people with high blood pressure know about it." According to Sanner, the result of the study primarily means a paradigm shift. "Target values are always an arbitrary decision - how should a value of 139 still be good and one of 141 bad?" The new goal of systolic 120 simply means that one should not be hasty satisfied with the blood pressure reduction.