press information / news

Epidemiology
23.11.2018

Early treatment has no survival benefits

When is high blood pressure dangerous? Medical associations offer widely differing answers. In the USA, for example, patients are seen as hypertensive much sooner than in Germany. A team of Helmholtz Zentrum München and the Technical University of Munich (TUM) has concluded in the ‘European Heart Journal’ that treating patients sooner does not reduce the risk of deadly heart disease. It could even negatively affect their mental health.

© Fotolia/Gina Sanders

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, 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. "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," explains Prof. Karl-Heinz Ladwig. He is a group leader at the Institute Epidemiology of Helmholtz Zentrum München and researcher at the Clinic for Psychosomatic Medicine and Psychotherapy at the TUM University Clinic rechts der Isar.

Motivation factor questionable

Using data from approximately 12,000 patients, Ladwig and his team assessed the situation in Germany. "We studied the 10-year risk of mortality from cardio-vascular disease (CVD) among people in the various hypertension categories in the context of the other risk factors affecting them," says Seryan Atasoy, the first author of the study, who is working as an epidemiologist at Helmholtz Zentrum München and Ludwig-Maximilians-Universität München.

In the newly created category Stage 1 Hypertension, the CVD mortality risk was not significantly higher than among patients with normal blood pressure. "The motivation effect is questionable, too," says Karl-Heinz Ladwig. 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, he explains. "At the same time, risk factors such as smoking and a lack of exercise are far more frequent in that group. That shows that many people do not change their lifestyles despite the diagnosis."

Dangerous depression

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. "We believe that 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 by Ladwig and his team showed that, in terms of mortality risk from cardio-vascular disease, depression is comparable to high cholesterol levels 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 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.


Further Information

Original Publication
Atasoy S. et al. (2018): Association of hypertension cut-off values with 10-year cardiovascular mortality and clinical consequences: a real-world perspective from the prospective MONICA/KORA study. European Heart Journal, DOI: 10.1093/eurheartj/ehy694 

As German Research Center for Environmental Health, Helmholtz Zentrum München pursues the goal of developing personalized medical approaches for the prevention and therapy of major common diseases such as diabetes mellitus, allergies and lung diseases. To achieve this, it investigates the interaction of genetics, environmental factors and lifestyle. The Helmholtz Zentrum München has about 2,300 staff members and is headquartered in Neuherberg in the north of Munich. Helmholtz Zentrum München is a member of the Helmholtz Association, a community of 18 scientific-technical and medical-biological research centers with a total of about 37,000 staff members. 

The Institute of Epidemiology (EPI) assesses genetic, environmental and lifestyle risk factors which jointly determine the occurrence of major chronic diseases. The focus is on the development and progression of metabolic, respiratory and allergic diseases, as well as heart diseases and mental health. The goal is to understand the molecular underpinning of disease better and to translate this knowledge into personalized approaches of prevention as well as polices to improve health. Research builds on the unique resources of the KORA cohort, the KORA myocardial infarction registry, and the KORA aerosol measurement station. Aging-related phenotypes have been added to the KORA research portfolio within the frame of the Research Consortium KORA-Age. Moreover, the institute makes use of the birth cohorts GINI and LISA. It plays a leading role in the planning and setting up of the German National Cohort and builds the NAKO biorepository.

The Technical University of Munich (TUM) is one of Europe’s leading research universities, with around 550 professors, 41,000 students, and 10,000 academic and non-academic staff. Its focus areas are the engineering sciences, natural sciences, life sciences and medicine, combined with economic and social sciences. TUM acts as an entrepreneurial university that promotes talents and creates value for society. In that it profits from having strong partners in science and industry. It is represented worldwide with the TUM Asia campus in Singapore as well as offices in Beijing, Brussels, Cairo, Mumbai, San Francisco, and São Paulo. Nobel Prize winners and inventors such as Rudolf Diesel, Carl von Linde, and Rudolf Mößbauer have done research at TUM. In 2006 and 2012 it won recognition as a German "Excellence University." In international rankings, TUM regularly places among the best universities in Germany.

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