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Blood pressure 120 instead of 140 the new blood pressure target?
The higher the blood pressure, the greater the risk of diseases such as heart attack or stroke. That hypertension should be treated, is undisputed among health experts. But currently there is a dispute over whether hypertension medication should reduce more than previously recommended. 120 is the new 140?
Increased risk of heart attack and stroke
It has long been known that with increasing blood pressure, the risk of heart attack and stroke increases. Often, high blood pressure can be defeated by a lot of sports and healthy nutrition. In addition, home remedies for hypertension may be supportive. But in many cases, drugs are needed. Recent research concludes that hypertension should be reduced more heavily than previously recommended. But should therefore millions of people swallow more medicines and nationwide antihypertensives are used?
Image: Christoph Burgstedt - fotolia In some patients, blood pressure should be lowered more
The so-called "Sprint" study in the USA came to the conclusion last year that at least for certain hypertensive patients, a systolic target value of 120 is cheaper than the previously targeted 140. As reported by the news agency dpa, since then also flock to German medical practices and clinics seeking patients. "Many ask when they will now be set to 120," said Yvonne Dörffel, head of the Department of Medicine at the Charité in Berlin. At present, German experts are still divided on the extent to which the result is practicable. "I do not see that that should be done at all with a higher number of high-pressure patients," said Dörffel.
Every third German has high blood pressure
According to data from the Robert Koch Institute (RKI), almost every third adult in Germany has hypertension. Not only is this associated with an increased risk of cardiovascular diseases such as stroke, coronary heart disease and heart failure, but also for chronic renal insufficiency and dementia. As physicians recently demanded in the journal "The Lancet", all patients with a high risk of heart attack or stroke should use antihypertensive medication, 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.
"Do not shake everything up"
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.
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. 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.
Significantly fewer deaths
In the "Sprint" study, two treatment approaches were compared, with some patients receiving intensive therapy targeting systolic blood pressure below 120. The other part got standard therapy, which was worth 140. Over 9,300 people were involved. The result, which was presented in the journal "New England Journal of Medicine", reads quite impressive. Thus, there was a good one-fourth fewer fatalities and one-third fewer cardiovascular events such as myocardial infarction, coronary syndrome, stroke or heart failure. Impressive, however, is the list of restrictions - and the side effects, it says in the agency message. Excluded from the study were people with diabetes mellitus or a previously-suffered stroke as well as people with symptomatic heart disease, protein secretions and secondary hypertension. These are patients whose hypertension is due to a specific illness such as sleep apnea or kidney disease. "Primary hypertension, which accounts for about 90 percent of cases, is due to genetic components and especially lifestyle factors," says Dörffel. These include stress, excessive salt intake, overweight, lack of exercise and a high-fat diet.
Heart failure is one of the leading causes of death
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.
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.
In addition, it was important to note in practice another crucial detail of the study: "The blood pressure was automatically measured with a special device, the patients sat in a quiet room," said Middeke. The doctor's effect, which raises the blood pressure in many people during the measurement, falls away with it. "That easily makes up 10 times." As it says in the dpa message, this means for the doctor visit that already a blood pressure of 125 to 130 correspond to the target value of the study. (Ad)