US guidelines refuted : Early BP treatment has no survival benefits

A new study published in European Heart Journal has reported that early treatment of hypertensive patients does not reduce the risk of deadly heart disease and could even negatively affect their mental health.

Seryan Atasoy and associates assessed the hypertension prevalence and associated cardiovascular disease (CVD) events in a sample of 11 603 participants from the MONICA/KORA prospective study to investigate the clinical value of a lower blood pressure (BP) cut-off for Stage 1 (S1) hypertension (130–139 mmHg systolic or 80–89 mmHg diastolic) in comparison to the currently established Stage 2 (S2) cut-off (≥140/90 mmHg) in a population-based cohort.

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The American College of Cardiology updated guidelines for high blood pressure and included "Stage 1 Hypertension." Under this, the doctors are advised to place patients in this category (130-139 mmHg / 80-89 mmHg) on treatment. For the European Society of Cardiology, that range is defined as "high normal" blood pressure, with no specific action recommended.

According to Prof. Karl-Heinz Ladwig, a researcher at the Clinic for Psychosomatic Medicine and Psychotherapy, the idea behind the US guidelines is to lower blood pressure as early as possible and, by presenting patients with a diagnosis, to encourage them to adopt a healthier lifestyle.

The study found that in the newly created category "Stage 1 Hypertension," the CVD mortality risk was not significantly higher than among patients with normal blood pressure. Patients in the high-risk category "Stage 2 Hypertension," where medication is recommended under both the US and the European guidelines, have a much greater risk of dying of heart disease. At the same time, risk factors such as smoking and a lack of exercise are far more frequent in that group.

There was one interesting finding in this research. 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 one subset of that group: those taking medication to treat their serious hypertension. Here, depressive moods were reported by around half of all patients, as opposed to just one-third of those not receiving treatment.

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"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 14 percent more who have to deal with the additional mental stress -- although their risk of developing a potentially deadly cardio-vascular condition is not significantly higher, and despite no real expectation of extra motivation through the diagnosis." For those reasons, Ladwig believes that it would be a serious mistake to adopt the US guidelines in Europe.

The study concluded that the lower BP cut-off substantially increased hypertension prevalence and participants under treatment were more likely to have a depressed mood in comparison to non-treated participants.

For full information log on to tps://doi.org/10.1093/eurheartj/ehy694