Blood pressure: how deep is deep enough?

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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A large US study on high blood pressure shook the professional world last year. It showed that the previous target values ​​for blood pressure may have been set significantly too high. Lowering it more could therefore save many lives.But how realistic are such low values? And who are they really useful for?

In September 2015, US researchers went public with the premature termination of the so-called SPRINT study. According to the interim results, one third less of the patients with upper blood pressure target values ​​below 120 mmHg died than of the participants for whom the currently valid limit value of 140 mmHg was aimed for.

Open questions

As clear as the results seem, they raise so many questions. Achieving the low target values ​​is difficult in many cases: "Less than half of high blood pressure patients even reach the target blood pressure of below 140/90 mmHg," says Prof. Heribert Schunkert from the German Heart Center in Munich. The big challenge is therefore to get the majority of patients to this value in the first place. Together with other experts from the German Heart Foundation, the cardiologist has taken on the complex topic.

Who should lower ambitiously ...

Basically, the decision for high blood pressure therapy depends on the patient's overall risk. For a patient who not only has high blood pressure, but also diabetes, for example, which also damages the organs, lower blood pressure values ​​are particularly important. The lowest possible values ​​are also crucial for young patients. Because the damage that high blood pressure causes to the vessels and organs add up over the decades.

The younger and healthier a hypertensive patient is, the closer he should be brought to 120 mmHg, says Schunkert. "If a young woman or a young man comes to me with a blood pressure of 140 mmHg, I say: 'There is more in it'." However, it is precisely the boys who particularly often do not even suspect that their values ​​are too high and therefore do not seek treatment.

... and who rather not

On the other hand, a low target value can even be unfavorable for some patients. This includes the very old who can have physical and mental problems when their blood pressure levels are low. But also for patients with coronary artery disease, in whom the coronary arteries are calcified, very low values ​​are risky: “You have to be very careful with them,” warns Schunkert.

In the opinion of the cardiologist, the old systolic target value should continue to apply to these patients: below 140 mmHg. Too drastic a decrease can quickly drop the lower (diastolic) value to below 60 mmHg. This endangers the blood flow to the heart, especially when the coronary arteries are severely narrowed.

"When treating high blood pressure, it is important to ensure that the patient can tolerate the therapy well in the long term," says Schunkert.

Treat patients individually

Keeping an eye on the patient and his or her individual risk factors and not drastically lowering blood pressure at any cost seems a wise strategy. Also because the SPRINT study shows that a whole arsenal of drugs would be necessary for many patients in order to achieve the desired value: one third of the patients examined required three, and another quarter even four or more different drugs. And any of them can have undesirable side effects. In particular, kidney problems are of concern to doctors.

In any case, it is worthwhile to lower your blood pressure at the same time by changing your lifestyle: reducing excess weight, physical activity, a low-salt diet, little alcohol - in this way, up to 10 mmHg less can be achieved. And that with only positive side effects. (cf)

Source:

Press release Deutsche Herzstiftung: SPRINT study: How low should blood pressure be lowered ?, 19.0.2016

* Randomized Trial of Intensive versus Standard Blood-Pressure Control, NEJM, Nov. 2015

[JR1] Somewhat simplified!

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