Hypertension Early diagnosis does not protect against fatal heart disease

New guideline for hypertension without benefits for those affected

No health expert doubts that high blood pressure represents a huge health risk. But when does he really get dangerous? In the US, hypertension patients will be treated for lower levels of treatment compared to here. However, protection against deadly heart disease is not achieved, German researchers report.

Risk factor for fatal cardiovascular diseases

High blood pressure (hypertension) is considered a widespread disease, especially in the Western world. In Germany alone, about 20 to 30 million people are affected. High blood pressure is a major risk factor for dangerous cardiovascular diseases such as heart attack and stroke. But where does dangerous hypertension begin? Health experts give different answers to this question. For example, patients in the US are considered ill earlier than in Germany. However, German researchers now report that this categorization is not necessarily beneficial for those affected.

In the US, blood pressure levels were lowered last year. Patients are therefore treated earlier. According to researchers, this does not provide protection against deadly heart disease. (Image: Kurhan / fotolia.com)

New blood pressure values

Until recently, hypertension was defined by a systolic blood pressure greater than 140 mmHg or a diastolic blood pressure greater than 90 mmHg.

But lately, voices have grown that say that 120 instead of 140 should be the new blood pressure target.

US medical societies have lowered their blood pressure guidelines last year (now 130/80 mmHg). Since then, there are up to 40 percent more than hypertensive patients.

However, a German research team headed by Prof. Karl-Heinz Ladwig from the Technical University of Munich (TUM) and the Helmholtz Zentrum München now concludes that a low threshold for treatment does not protect against fatal heart disease.

Patients should be encouraged to healthier lifestyles

As the TUM has reported in a communication, the American College of Cardiology guidelines have included an additional category for hypertension since 2017: "Stage 1 Hypertension"..

Accordingly, patients must be treated with the appropriate values ​​(130-139 mmHg / 80-89 mmHg). The European Society of Cardiology, on the other hand, still sees these values ​​as having an "elevated normal blood pressure" and no compelling need for action.

"The idea behind the US guidelines is to reduce high blood pressure as early as possible and to motivate patients to live healthier lives by diagnosing a disease," explained Prof. Karl-Heinz Ladwig, a researcher at the Department of Psychosomatic Medicine and Psychotherapy of the TUM. University Hospital on the right of the Isar and at the Helmholtz Zentrum München.

Ladwig and his team have obtained a picture of the situation in Germany based on data from almost 12,000 patients.

"We looked at what was the risk for people in the different 'blood pressure categories' to die from cardiovascular disease over a ten-year period and what other risk factors were present," said Seryan Atasoy, first author of the study and Epidemiologist at the Helmholtz Zentrum München and the Ludwig-Maximilians-University Munich.

The results of the study were published in the European Heart Journal.

Motivational effect is questionable

According to the information, the risk of dying of cardiovascular disease in the newly created category "Stage 1 hypertension" was not significantly higher than with normal blood pressure.

"The motivational effect is also questionable," says Karl-Heinz Ladwig.

Drugs with dangerous high blood pressure, which should be treated with both US and European guidelines ("Stage 2 Hypertension"), significantly increase the risk of dying from cardiovascular disease.

"At the same time, risk factors such as smoking and physical inactivity are particularly pronounced. This shows that many do not change their lifestyle despite the diagnosis. "

While persons with dangerous hypertension were less likely to be depressed than others, the value was significantly higher for a subset:

About half of those who took medications because of the dangerous high blood pressure had depressive moods.

For the non-treated, this was only the case for around a third.

Depression as a risk factor for cardiovascular disease

"We assume that this is a labeling effect," said Ladwig. "Being officially labeled 'sick' will affect your mental health."

In a previous study, Ladwig and his team had already shown that depression poses a similarly high risk factor for fatal cardiovascular diseases, such as high cholesterol levels or obesity (obesity).

"Our data shows that depression reaches a median effect size within the major non-congenital risk factors for cardiovascular disease," Ladwig said in a statement.

He suggested: "In high-risk patients, the diagnostic evaluation of depression as a concomitant disease should be standard. That could be grasped with simple means. "

Additional mental pressure

"The American College of Cardiology itself has calculated that the proportion of adults diagnosed with hypertension increases from 32 to 46 percent," said Karl-Heinz Ladwig.

"14 percent are thus additionally delivered mental pressure - without that they would be significantly more likely to develop a fatal cardiovascular disease and without that a motivational effect of the diagnosis would be expected."

Therefore, from the point of view of Ladwig, adoption of US guidelines in Europe would be fundamentally wrong. (Ad)