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New blood pressure limits in the US 35 million people have fallen ill overnight

New blood pressure limits in the US 35 million people have fallen ill overnight

New blood pressure limits in the US35 million people have fallen ill overnight

Because high blood pressure can cause serious illnesses, US doctors have now set stricter limits. That makes many healthy people sick. Germany will follow suit – how useful is that?

The experts are thus responding to scientific findings from previous years, according to which even a slight increase in blood pressure above the normal value of 120/80 mmHg can lead to health problems. High blood pressure is one of the most important risk factors for heart attacks, heart failure and strokes besides smoking . Cardiovascular diseases are the leading cause of death in Western countries.

In Germany, other values apply: in this country, a patient has high blood pressure, if its values are 140/90 mmHg and above. Anyone who has been a new high-blood-pressure patient in the US since Monday would be considered “highly normal” in Germany.

Definition and Classification of Practice Blood Pressure (mmHg) *

category systolic diastolic
Optimal <120 and <80
normal 120-129 and or 80-84
high normal 130-139 and or 85-89
Hypertension grade 1 140-159 and or 90-99
Hypertension grade 2 160-179 and or 100-109
Hypertension grade 3 ≥180 and or ≥110

 

What sounds like different terminology alone has far-reaching consequences. For while only 32 percent of the population in the US had pathological values, the disease affects 46 percent according to the new limits . These 14 additional percent represent nearly 35 million people.

“I am amazed that the new definition will suddenly confront so many people in the United States with the disease hypertension,” says blood pressure expert Roland Schmieder of the University Hospital Erlangen. He is involved in the preparation of the European Guidelines for Hypertension. “We will probably also lower our target values in Europe and Germany,” says Schmieder. “But we will try to differentiate more to prevent overtreatment.”

In the summer of 2018, the revised guidelines will be published and, shortly afterwards, adapted for Germany. “The scientific findings from recent years have clearly shown that it makes sense to aim for lower target values than hitherto,” says Schmieder. “Whether the values are lowered to 135/85 or 130/80, but is still unclear.”

Some underlying studies such as the so-called Sprint study are controversial. In 2015, it came to the conclusion that people with an increased risk of cardiovascular disease are less likely to die or die prematurely if their blood pressure is lowered to 120. The criticism of the investigation : the method of measurement for blood pressure is different from the measurements that are performed in medical practice and therefore can not be transferred to the daily lives of millions of patients. However, other meta-analyzes are included in the guidelines, which also speak in favor of a stricter adjustment of blood pressure.

But in Schmieder’s eyes not every patient with high blood pressure levels has to get medication. But where a diagnosis is, the therapy is often not far away.

The questions are close:

  • How many of the new high-pressure patients in the US and soon in Germany have to swallow pills?
  • Do the new limits mean that healthy people are labeled as sick?
  • Do the positive effects of lowered high blood pressure actually weigh the dangers and side effects of drug therapy, such as kidney damage, high blood pressure fluctuations, fatigue?

“Yes, we’re labeling more people than high blood pressure patients and we’re going to prescribe more medications,” says Kenneth Jamerson, co-author of the US Guidelines and cardiologist at the University of Michigan. But you will save lives and save money by preventing more strokes and cardiovascular disease. When asked about conflicts of interest, five of the 22 guideline authors stated that they were receiving funds from biotech or pharmaceutical companies.

However, according to the publication, the goal is not to drug-treat all newly-added patients: “About one in five will need medication,” says Policy Committee Chairman Paul Whelton. The remainder of the remainder is designed to help physicians focus on working with their patients towards a healthier lifestyle.

Paulus Kirchhof, director of the Institute of Cardiovascular Sciences at the University of Birmingham, UK, and author of the European guidelines, now sees both doctors and patients as having the duty: “Many people could lower their high blood pressure by move more, eat healthy, do not smoke, sleep regularly and drink little alcohol , “says Kirchhof. “Such a conversation must lead doctor and patient, medicines are not always the right way.” In the individual case, it must always be weighed whether the cardiovascular risk is greater or the possible side effects of drug therapy.

However, it has been known for decades that exercise, healthy eating, quitting smoking and a normal weight are important for good health . In the number of overweight but that has not changed, on the contrary. The absence of smoking is less due to the recognition of health hazards than to smoking bans in restaurants and public institutions.

Under these circumstances, will a general practitioner really be able to persuade his patients in short conversations to move more and eat healthier? Maybe he is more likely to reach for the recipe block and prescribe a drug.

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