Blood pressure values: 120 instead of 140 the new blood pressure target?

Blood pressure values: 120 instead of 140 the new blood pressure target?

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Treating high blood pressure: what blood pressure should the goal be?
The higher the blood pressure, the greater the risk of diseases such as heart attack or stroke. The fact that high blood pressure should be treated is undisputed among health experts. However, a dispute is currently raging over whether medication should reduce hypertension more than previously recommended. Is 120 the new 140?

Increased risk of heart attack and stroke
It has long been known that the risk of heart attack and stroke increases with increasing blood pressure. Often, high blood pressure can be overcome through lots of exercise and healthy eating. Home remedies for high blood pressure can also help. But in many cases, medication is required. Recent studies have come to the conclusion that hypertension should be reduced by medication more than previously recommended. But should millions of people swallow more medication and blood pressure lowerers be used across the board?

In some patients, blood pressure should be reduced 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 the dpa news agency reports, it has since flocked to German medical practices and clinics seeking advice. "Many ask when they will now be set to 120," said Yvonne Dörffel, head of the Charité medical polyclinic in Berlin. At the moment, German experts are still divided on the extent to which the result is practical. "I don't see that this should be done with a higher number of high-pressure patients at all," says Dörffel.

Every third German has high blood pressure
According to data from the Robert Koch Institute (RKI), almost every third adult in Germany has high blood pressure. This is associated not only with an increased risk of cardiovascular diseases such as stroke, coronary heart disease and heart failure, but also for chronic renal failure and dementia. As doctors recently said in The Lancet, all patients at high risk of heart attack or stroke should be given antihypertensive medication regardless of their blood pressure. According to the scientists who evaluated 123 studies involving over 600,000 people, the 140 threshold was too high for treatment with tablets. However, they noted that some of the studies were only partially comparable.

"Don't shove everything together"
The head of the Munich Hypertension Center, Martin Middeke, commented critically on the meta-analysis: “You can't shove everything together. The treatment of blood pressure is always an individual therapy. “For example, previous illnesses should also be taken into account.
The guideline for drug treatment is currently around 140/90. Patients who have high blood pressure below this level are usually advised to change their lifestyle. Bernd Sanner, chief physician at the Agaplesion-Bethesda Hospital in Wuppertal, said that large studies have long known that blood pressure is associated with increased mortality from around 115/70. "Conversely, the question was then asked: If you try to lower your blood pressure, which target value makes sense from a health point of view?" Said the expert.

Significantly fewer deaths
In the "Sprint" study, two treatment approaches were compared, with some of the patients receiving intensive therapy that aimed at systolic blood pressure below 120. The other part received standard therapy, which was aimed at a value of 140. Over 9,300 people were involved. The result, which was presented in the journal "New England Journal of Medicine", reads quite impressive. According to the study, intensive therapy resulted in a quarter fewer deaths and a third fewer cardiovascular events such as heart attack, coronary syndrome, stroke or heart failure. However, the list of restrictions is also impressive - and that of side effects, according to the agency report. People with diabetes mellitus or a previously suffered stroke as well as people with symptomatic heart disease, protein excretion and secondary hypertension were excluded from the study. These are patients whose high blood pressure is due to a specific illness such as sleep apnea or kidney disease. "The primary hypertension, which accounts for about 90 percent of cases, is due to genetic components and, above all, lifestyle factors," says Dörffel. These include stress, excessive salt consumption, obesity, lack of exercise and a high-fat diet.

Heart failure is one of the main causes of death
Dörffel explained that the widespread view of the study results was that the third fewer cardiovascular events related primarily to strokes and heart attacks, but: "That is wrong, there is no clear difference." Rather, there is a decrease, especially in the number of heart failure . According to dpa, HZM's Middeke said it was very surprising that a drastic reduction did not affect the number of strokes and heart attacks. "Heart failure is generally one of the main causes of death in the age group tested - and the majority of the drugs used are exactly the same as those used for heart failure," Dörffel explained her theory. It therefore suggests that the intensive therapy prevented cardiac insufficiency, but that the blood pressure setting played a minor role in the reduced death rate.

Big differences between men and women
According to Middeke, there were also big differences between men and women. The risk of cardiovascular events with intensive therapy was 28 percent lower in men, but only 16 percent in women. "In this respect, you have to see exactly who can ultimately benefit from intensive therapy," said Middeke. "You cannot generalize the result." In Germany, blood pressure patients would visit the doctor about every three to six months. "With a goal of 120, monthly checks are necessary because the side effects are greater," said Sanner. This is a big challenge for the already full practices. "But this effort is worthwhile," says the chief doctor.

He believes that an adjustment to a target value of 120 would make sense for some of the over-75-year-old blood pressure patients and for over 50 people with cardiovascular risks. "That is already a relevant part, definitely 30 to 40 percent of all patients." But each case had to be considered and decided individually. "You have to be pragmatic: it doesn't make sense to set someone to 120 when they fall down or are no longer efficient," said Sanner, dpa. In general, it would be a long way to achieve the new goal with all those for whom it made sense. "Currently, just over 50 percent of hypertension 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 in Germany, only one in ten reached the target value." In addition, according to an evaluation by the RKI, knowledge of one's own value is now much better. "80 percent of people with high blood pressure know about it." According to Sanner, the study result means above all a paradigm shift. "Target values ​​are always an arbitrary definition - how should a value of 139 still be good and one of 141 bad?" The new target of systolic 120 simply means that one should not be satisfied with the blood pressure reduction prematurely.

In addition, it was important to note another crucial detail of the study in practice: "The blood pressure was measured automatically with a special device, the patients sat in a quiet room," said Middeke. The doctor effect, which makes the blood pressure in many people go higher when measuring, is thus eliminated. "That easily makes 10 times." As it says in the dpa report, this means for the doctor's visit that a blood pressure of 125 to 130 already corresponds to the target value of the study. (ad)

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