Often unnoticed for a long time, high blood pressure damages the heart, blood vessels, brain or kidneys. Until it was a heart attack, a brain hemorrhage, a stroke. The German Heart Foundation estimates that the body is struggling in more than 20 million people in Germany.
The problem is that despite high blood pressure values, it is usually possible to live well without symptoms. Affected individuals experience dizziness, ringing in the ears, or nosebleeds from time to time. But the vessels and organs are damaged in secret. The body gets used to the constant stress and compensates for it until it is no longer possible.
High blood pressure is rarely fate
A blood pressure of 100 to 110 mmHg is naturally ideal. One mmHg means the pressure exerted by one millimeter of a column of mercury. “Above this value, the risk of cardiovascular disease increases more or less linearly, we know this from large studies,” says Heribert Schunkert, director of the Clinic for Cardiovascular Diseases at the German Heart Center in Munich.
There are two levers to reduce goodwill: lifestyle and medication. “Low salt, lots of exercise, eating healthy overall and getting rid of excess weight – none of this usually harms anyone and usually shows clear effects in patients with hypertension,” Schunkert says. As an indication: for each kilo that you lose, your blood pressure drops by 1 mmHg.
Medication is needed from 140
Doctors need to take a closer look at whether the patient needs to take medication. You need it if you measure 140 mmHg and above on a long-term basis. Schunkert: “Studies here have shown that the active ingredients can be very helpful in reducing the risk of stroke, heart failure, kidney disease or heart attack.”
It gets more confusing, Schunkert points out, when blood pressure is just under 140 without medication. Different studies come to different conclusions. Overall, however, it seems that the drugs would then no longer be of much use.
Many ignore their problems
If patients are already taking medication, it is best to lower their blood pressure to 120 or 130 immediately. it’s just not necessary for many patients”.
But even that cannot be generalized, as an ongoing study from the University of Ulm and the Agaplesion Bethesda Clinic shows: About three-quarters of all 75-year-olds have high blood pressure that is treated with medication. . The Ulm researchers say that it is better not to do this for frail people. Because then more falls are programmed, which increases the risk of death due to complications such as a fracture of the neck of the femur.
Data from over 1100 seniors
The scientists evaluated the data of more than 1100 elderly people. For those who were fitter, a blood pressure of 130 was optimal; this is also recommended by medical guidelines. However, among the frail, participants with a blood pressure of 160 had the lowest risk of death.
Schunkert adds: Does the potential effect of the drug really outweigh the risk of side effects? How is the active substance tolerated? And what options for lifestyle changes may not have been fully exhausted yet?
For some, jogging doesn’t help
There are also cases where high blood pressure cannot be controlled with regular jogging. These patients have inherited the predisposition, the drugs help them. In some cases, high levels are also linked to the kidneys. Then, for example, their arteries are narrowed, the organ is reduced, or it is full of cysts. Kidney damage causes more hormones to be released, which increases blood pressure.
Conversely, hypertension damages the kidneys: their fine vessels become inflamed and narrow. In order to remain functional and to move blood through the vascular system, more pressure is needed. A vicious circle is created. To interrupt it, an operation is performed in case of particularly severe arterial hypertension: the nerve fibers of the renal artery are sclerotic.
Sport and other diets are obstacles
The majority of hypertensive patients are not, emphasizes Munich doctor Heribert Schunkert, the vast majority could influence their values. The difficulty lies in the motivation. Anyone who has avoided sports all their life and has a fondness for meat and sausages will find it easier to pop a pill or two than turn their life upside down. Especially since the drugs are often prescribed.
Patent protection has expired for almost all antihypertensive drugs, so they are cheap. And the work. Schunkert would like a little more ambition here: “Lowering blood pressure is a team effort, and we doctors shouldn’t make it so easy for our patients.” Cardiologists have repeatedly discussed the sensitivity of high blood pressure limits. The debate last boiled over in the fall of 2017 when a group of American experts corrected the specifications downwards.
In Europe, a doctor currently diagnoses high blood pressure when the systolic reading is 140 or higher and the diastolic reading is 90 or higher. This was also the case in the USA for a long time. In 2017, the American College of Cardiology and the American Heart Association changed the scores to 130 and 80. The European Society of Cardiology considers this to be “normally high blood pressure”, i.e. it does not need treatment. The redefinition suddenly turned one in three Americans into hypertensive patients, up from one in four.
The trigger for the stricter approach of the Americans was the so-called Sprint study of 2015. According to this study, people with an increased risk of cardiovascular disease die less often earlier if their systolic blood pressure can be reduced to 120. However, the study data is controversial because the blood pressure for these examinations was measured differently from what is normally the case in daily medical practice. Critics say this led to false results.
Things are bad in Germany
If lower limits mean people are more concerned about their blood pressure, then they’ve achieved their goal, says Franz-Josef Neumann. He sees it with pragmatism. “The question is: when do you start correcting?” says the medical director of the Clinic for Cardiology and Angiology II at the University Heart Center Freiburg, Bad Krozingen. “At the time, the Americans had decided that they would start earlier than before, so that the threshold for counseling patients would be lower. This does not automatically mean that the patient receives medication. First and foremost , he will give advice on the influence of a healthy lifestyle on high blood pressure.
In Germany, despite all the progress in blood pressure control, things are still going badly. About a fifth of patients are unaware of their condition, Neumann says, and of those who are treated, a third don’t even hit the target because the treatment isn’t consistent enough. European Society of Cardiology guidelines recommend a general treatment goal below 140 and 80, as well as below 130 and 80 for those under 70 at increased risk. “Ultimately, only about half of high blood pressure patients are well adjusted,” Neumann calculates.
When does high blood pressure need treatment?
A team from the Helmholtz Center Munich and the Technical University of Munich investigated whether it actually saves human lives if the threshold above which blood pressure is considered to require treatment is lowered further. In their study published in the European Heart Journal in 2018, the researchers evaluated data from around 12,000 patients and found no protective effects at lower cutoff values.
The scientists discovered a completely different link: “We found depressed moods in about half of the patients who were taking medication for hypertension,” says epidemiologist Seryan Atasoy, first author of the study. Only a good third of untreated participants felt exhausted.
effect on mental health
“We think it’s kind of a labeling effect,” Atasoy explains, “when you call people sick, it affects their mental health. They might not think of themselves as sick before, and they don’t maybe they didn’t feel that way, and they got sick.” Depression, in turn, is a risk factor for more serious cardiovascular disease.
Atasoy therefore advocates that the limit values should only be used as a guide: “Instead, individual factors should decide whether blood pressure should be treated with medication or not: What other risks does the patient bring with him ? Does he smoke Are there other comorbidities? »