Those who don’t belong to the fortunate people with clearly normal blood pressure, but rather lie slightly above it, have been confronted with different and often confusing messages for years. At its core, it’s always about when blood pressure is considered in need of treatment and what value should be targeted as the goal of drug therapy.

While decades ago an upper value of 100 plus age was acceptable (for a 60-year-old, that would correspond to 160 mmHg), doctors today draw much lower limits. The so-called SPRINT study even concluded in 2015 that it would be best to push the upper value below 120 mmHg.

Current Blood Pressure Classification

The current threshold values according to the classification of the World Health Organization WHO, the European Society of Cardiology, and the German Hypertension League:

Drug treatment is therefore only required from values of 140/90 mmHg onwards, when Grade 1 hypertension, mild high blood pressure, is present.

The Controversial Borderline Range

Experts particularly disagree on how to deal with values in the range of 130-140/85-90 mmHg. Is this still healthy or already sick? Doctors from the USA have decided on the latter.

The American College of Cardiology has introduced an additional category in its guidelines: “Stage 1 Hypertension.” This is particularly significant because American cardiologists already consider this value to require treatment: patients in whom it is repeatedly measured are therefore prescribed blood pressure-lowering medications.

American vs. European Guidelines

Often the USA are pioneers in medicine, and Europeans follow a little later. In the case of assessing slightly elevated blood pressure values, however, this is not emerging. At their congress in September 2018, the European Society of Cardiology decided to maintain the previous threshold values.

Munich Study: Negative Effects of Early Treatment

A team of scientists from the Technical University of Munich (TUM) and the Helmholtz Center Munich now supports the European decision. The researchers concluded that such a low threshold for treatment provides no protection against fatal cardiovascular disease.

“The idea behind the US guidelines is to lower blood pressure as early as possible and motivate patients through the diagnosis of a disease,” explains Karl-Heinz Ladwig, researcher at the Clinic for Psychosomatic Medicine and Psychotherapy at the TUM University Hospital rechts der Isar.

Together with his team, he analyzed data from nearly 12,000 patients over a period of ten years. The result: In the category “Stage 1 Hypertension” newly created by American cardiologists, the risk of dying from cardiovascular disease was not significantly higher than with normal blood pressure.

The Psychological “Labeling Effect”

Karl-Heinz Ladwig also sees the motivational effect postulated by US doctors as questionable. As justification, he cites the example of patients with dangerously high blood pressure: In this group, smoking and lack of exercise are particularly widespread – both are among the biggest risk factors for high blood pressure.

In people with borderline blood pressure between 130-139/85-89 mmHg, a completely different risk factor can come into play. It has been known for some time that there are manifold interactions between psychological crises, depression, and cardiovascular events.

The Munich scientists had shown in an earlier study that depression burdens the cardiovascular system similarly to high cholesterol levels and obesity.

According to calculations by the American College of Cardiology, the new guidelines in the USA will increase the proportion of adults with a diagnosis of high blood pressure from 32 to 46 percent. “14 percent will thus be subjected to additional psychological pressure,” says Ladwig – “without there being a significantly higher danger for them to develop fatal cardiovascular disease and without a motivational effect of the diagnosis being expected.”

Lowering Blood Pressure Naturally

The European Society of Cardiology recommends lowering blood pressure values naturally when blood pressure is in the high-normal range. Even though it’s difficult and many don’t maintain it long-term: Through lifestyle changes, even people with pronounced high blood pressure can manage to do without medications or at least significantly reduce their dosage.

According to the German Heart Foundation, blood pressure can be lowered particularly effectively through weight loss. Three-quarters of all overweight people suffer from high blood pressure. Experts point out that not all sports are equally suitable and that any increase in daily movement helps.

Conclusion and Recommendations

Instead of hastily turning to medications, lifestyle measures should take priority for values in the high-normal range. Diet can affect not only blood pressure but also influence other health risks.

An individualized consideration of each patient remains crucial – not every borderline value requires immediate drug intervention.

Original source: Frankfurter Rundschau – “Don’t lower high blood pressure too early with medications”