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In some patients, lowering blood pressure is not healthy
People with high blood pressure are usually advised to lower it, thereby reducing the risk of cardiovascular diseases such as heart attacks. But German researchers have now found that it is not advisable for all patients if their blood pressure is adjusted to the applicable guidelines.
Risk of death increases
Physicians have previously believed that it is healthier for older people to lower their blood pressure below 140/90 mmHg. But researchers at Charité - Universitätsmedizin Berlin have determined that this assumption does not apply to all hypertension patients. On the contrary, the risk of death increases for people who are older than 80 or who have already had a stroke or a heart attack.
Changed blood pressure guidelines
As the professional association of German internists (BDI) writes on its website "Internisten im Netz", around 70 to 80 percent of those over 70 have high blood pressure, which can lead to long-term life-threatening cardiovascular diseases such as a heart attack or stroke.
When deciding whether and how doctors treat people with hypertension, they follow the recommendations of the professional associations.
According to the European guidelines, blood pressure in people over 65 should be set below 140/90 mmHg to protect them from life-threatening heart diseases.
These target values also apply to people over the age of 80, but they have to consider individual factors such as comorbidities.
New blood pressure guidelines have been in force in the USA since 2017. Specialist societies such as the American College of Cardiology (ACC) and the American Heart Association (AHA) recommend setting blood pressure below 130/80 mmHg for all hypertension patients older than 65 years.
However, the current scientific debate is currently focusing on which target values are actually the best for the treatment of older people with high blood pressure.
No basic protective effect
Charité researchers have now been able to show in an observational study that lowering blood pressure to below 140/90 mmHg - and especially below 130/90 mmHg - does not in principle have a protective effect.
The analysis is based on epidemiological data from more than 1,600 women and men who were at least 70 years old at the start of the study in 2009 and were on antihypertensive treatment.
As the researchers found, those over the age of 80 who had blood pressure below 140/90 mmHg were 40 percent more likely to die than those who had blood pressure above 140/90 mmHg.
The research team made a similar observation among the study participants who had previously had a stroke or heart attack:
For those whose blood pressure was below 140/90 mmHg, the risk of death even increased by 61 percent compared to those whose blood pressure remained above this limit despite drug treatment.
The results of the study were published in the European Heart Journal.
"Our results make it clear that the treatment of high blood pressure in these patient groups should be individually adjusted," said Dr. Antonios Douros from the Institute for Clinical Pharmacology and Toxicology at the Charité in a communication.
"We should get away from applying the recommendations of the professional associations to all patient groups," emphasized the first author of the study.
[GList slug = ”10-signs-for-hypertension”]
About the study
According to the information, the epidemiological data in the context of the “Berlin Initiative Study”, which was developed by Prof. Dr. Elke Schäffner, Deputy Director of the Charité Institute for Public Health.
Her team interviewed the study participants every two years about their illnesses and medication, measured blood pressure and kidney function and analyzed blood and urine.
After six years, statistical methods were used to investigate the extent to which the blood pressure measured at the start was related to death.
Factors such as gender, body mass index, smoking status, alcohol consumption, diabetes and the number of antihypertensive agents were also taken into account.
"Next we want to investigate which patient groups actually benefit from a drop in blood pressure," says Prof. Schäffner. (ad)