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Setting high blood pressure Heart experts rely on previous blood pressure target values
In Germany, about 20 to 30 million people are affected by hypertension. Often, medication is needed, but often a healthier lifestyle is enough to lower blood pressure. How far this should be reduced, is now controversial. The experts of the German high pressure league hold on to moderate targets.
Risk factor number one for cardiovascular diseases
In Germany, about 20 to 30 million people suffer from hypertension. Hypertension is usually defined by a systolic blood pressure greater than 140 mmHg and a diastolic blood pressure greater than 90 mmHg. Meanwhile, however, the voices are growing, suggesting that 120 instead of 140 should be the new blood pressure target. However, due to the current data situation, the German Hypertension League e.V. DHL® - German Society for Hypertension and Prevention holds on to moderate target values and emphasizes the need for exact measurements.
Lower blood pressure to 120 to 80. (Image: M.Dörr & M.Frommherz / fotolia.com)Lower blood pressure naturally
High blood pressure is not felt by the patients for a long time and often only occurs when it causes organ damage. He is therefore - as well as other diseases - referred to as a "silent killer".
A large part of those affected take antihypertensives. However, hypertension can often be reduced without medication.
In addition to weight loss, regular exercise and quitting smoking, a balanced, healthy diet can help reduce blood pressure.
Very important here is: salt only in moderation. A high salt diet can increase blood pressure. Not more than four to six grams of salt should be consumed per day.
Some home remedies for hypertension such as Kneipp's applications can provide good support.
But what blood pressure values should be sought?
Study results are only for specific patients
The American SPRINT study found in 2015 that high blood pressure reduction to an upper systolic target of less than 120 mmHg better protects people with high blood pressure from heart attacks, strokes, heart failure and cardiovascular death than their preferred target of less than 140 mmHg.
However, as DHL writes in a recent press release, these study results only apply to certain patients: for people at high cardiovascular risk, but without diabetes mellitus, not after a stroke, or during orthostatic hypotension, when the upper blood pressure drops suddenly when standing.
Patients with these diseases were explicitly excluded from the SPRINT study.
Moderate target blood pressure is far from being reached by all
The medical societies in Canada, Australia and Austria, as well as the International Society of Hypertension (ISH) have recommended a more intense blood pressure reduction since the SPRINT data was published, although this often requires the use of additional medications.
DHL's Task Force Scientific Opinions and Guidelines did not fully agree with these recommendations in its current opinion.
"Due to the extended data according to SPRINT as well as related publications and meta-analyzes, we still recommend a general target value of less than 140/90 mmHg," explained Professor Dr. med. Bernhard Krämer, DHL CEO and member of the Task Force.
In Germany, the moderate target blood pressure of 140/90 mmHg is currently achieved in less than 60 percent of patients. "The most important treatment goal for all doctors must therefore be that this blood pressure target is achieved," said the expert.
More intense blood pressure reduction is associated with more side effects
Only in the case of cardiovascular risk patients analogous to SPRINT should a value of less than 135/85 mmHg be sought, according to the "Recommendations 2017".
This applies to patients with cardiovascular disease, except stroke, at the age of 75 years or older, with chronic kidney disease CKD 3 and a high vascular risk.
"A more intense blood pressure reduction goes hand in hand with more side effects," explained Professor Krämer. "It therefore requires regular laboratory tests on kidney function and electrolytes."
DHL's "Recommendations 2017" were recently published in the "German Medical Weekly".
Blood pressure measurement and standard values
The current statement from DHL also addresses blood pressure measurement. In the SPRINT study, an unconventional way of measuring blood pressure - the automated blood pressure measurement - was used.
It took place after five minutes of rest with an automatic device in a separate room without the presence of medical or non-medical personnel.
"This method will not be universally available and practicable in the long term in Germany," said Professor Krämer. "It was used to measure values in the SPRINT study that we can not compare one to one with conventionally measured values".
The "Recommendations 2017" refer in their statements to the conventional practice blood pressure measurement.
Even in Germany, more and more patients control their own blood pressure. DHL expressly supports this, but points out that the measured values are usually slightly lower than in the doctor's office.
The reason is an increased stress factor at the doctor's visit. In self-measurement, therefore, a target value of less than 135/85 mmHg applies.
Professor Krämer explained: "At least one week before the next visit, patients should take four measurements a day for seven days at home - two in the morning, two in the evening."
The most reliable information about blood pressure provides 24-hour blood pressure measurement. Here a target value of less than 130/80 mmHg applies. (Ad)