When is high blood pressure dangerous? Medical associations offer very different answers. In the United States, for example, patients are seen as hypertensive long before in Germany. A team working with Professor Karl-Heinz Ladwig of the Technical University of Munich and the Helmholtz Zentrum München concluded that treating patients before does not reduce the risk of fatal heart disease. It could even negatively affect your mental health.
In 2017, the American College of Cardiology added a new category to its guidelines for high blood pressure: "Stage 1 Hypertension." Under the new standards, physicians are recommended to place patients in this category (130-139 mmHg / 80-89 mmHg) under treatment. For the European Society of Cardiology, this range is defined as "normal high" blood pressure, with no recommended specific action.
"The idea behind the US guidelines is to lower blood pressure as soon as possible and, by presenting patients with a diagnosis, encourage them to adopt a healthier lifestyle," explains Professor Karl-Heinz Ladwig, researcher of the Clinic for Psychosomatics. Medicine and psychotherapy in the university clinic TUM rechts der Isar in Helmholtz Zentrum München.
Questionable motivation factor.
Using data from approximately 12,000 patients, Ladwig and his team evaluated the situation in Germany. "We studied the 10-year risk of mortality from cardiovascular disease (CVD) among people in the different categories of hypertension in the context of the other risk factors that affect them," says Seryan Atasoy, the study's first author, who is working as a Epidemiologist at Helmholtz Zentrum München and Ludwig-Maximilians-Universität München.
In the newly created category "Stage 1 hypertension", the risk of CVD mortality was not significantly higher than among patients with normal blood pressure. "The effect of motivation is also questionable," says Karl-Heinz Ladwig. Patients in the high risk category "Stage 2 Hypertension", where medication is recommended according to US guidelines. UU And the European, they have a much greater risk of dying from a heart disease, he explains. "At the same time, the risk factors such as smoking and lack of exercise are much more frequent in that group, which shows that many people do not change their lifestyle despite the diagnosis."
Although the incidence of depression is generally lower among people with dangerously high blood pressure than in the general population, depression was significantly more common in a subgroup of that group: those who take medications to treat their severe hypertension. Here, about half of the patients reported depressive moods, instead of only a third of those who did not receive treatment.
"We think this should be seen as a labeling effect," says Ladwig. "When people are officially labeled as 'sick', that has an impact on their mental health." A previous study conducted by Ladwig and his team showed that, in terms of risk of mortality from cardiovascular disease, depression is comparable to high cholesterol or obesity.
New guidelines mean more sick people
"The American College of Cardiology itself has calculated that the proportion of adults diagnosed with high blood pressure will increase from 32 to 46 percent," says Karl-Heinz Ladwig. "That means that 14 percent more have to deal with additional mental stress, although their risk of developing a life-threatening cardiovascular condition is not significantly greater, and in spite of not having a real expectation of additional motivation through diagnosis." For these reasons, Ladwig believes that it would be a serious mistake to adopt the United States guidelines in Europe.
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Materials provided by Technical University of Munich (TUM). Note: The content can be edited by style and duration.