Munich, Germany—European researchers are taking issue with new United States guidelines for high blood–pressure treatment.
The report in the European Heart Journal notes that in 2017, the American College of Cardiology added a new category to its 2017 guidelines for high blood pressure, “Stage 1 Hypertension,” defined as 130-139 mmHg/80-89 mmHg, and urged that the condition be treated.
The European Society of Cardiology defines that range as “high normal” blood pressure, with no specific action recommended.
A team led by researchers from the Technical University of Munich and the Helmholtz Zentrum München concludes after a prospective study that treating hypertension patients sooner does not reduce the risk of deadly heart disease and could negatively affect their mental health. The researchers recommend against the U.S. guidelines being adopted in Europe.
“The idea behind the U.S. 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,” explained coauthor Karl-Heinz Ladwig, PhD, who adds that unexpected consequences might be occurring.
Using a population-based cohort, the study team investigated the clinical value of a lower blood pressure (BP) cut-off for stage 1 (S1) hypertension versus the currently established stage 2 (S2) cut-off, ≥140/90 mmHg.
Participants were drawn from the MONICA/KORA prospective study; the sample of 11,603 had a mean age of 47.6 years; 52% were men. Results indicate that implementation of the new S1 cut-off increased the prevalence of hypertension from 34% to 63%, and that only 24% of S2 hypertension patients were under treatment.
Over a decade of follow-up, 370 fatal CVD events were observed, with the adjusted CVD-specific mortality rate per 1,000 persons calculated as 1.61 [95% confidence interval (CI) 1.10–2.25] cases in S2 and 1.07 (95% CI 0.71–1.64) cases in S1 hypertension, compared with normal BP.
While the analysis demonstrated a significant association between S2 and CVD mortality (1.54, 95% CI 1.04–2.28, P = .03), statistical significance for S1 hypertension was not reached (0.93, 95% CI 0.61–1.44, P = .76), researchers report.
At the same time, they note, a significantly higher prevalence of depressed mood was detected in treated patients among S2 participants (47%), compared with nontreated patients (33%).
“The lower BP cut-off substantially increased hypertension prevalence, while capturing a population with lower CVD mortality,” study authors conclude. “Additionally, participants under treatment were more likely to have depressed-mood in comparison to non-treated participants, which might reflect a negative labelling effect.”
The study points out that depression was significantly more common in those taking medication to treat their serious hypertension, with depressive moods reported by about half of all patients versus just one-third of those not receiving treatment.
“We believe that this should be seen as a labeling effect,” Ladwig suggests. “When people are officially labeled as ‘sick’, that has an impact on their mental health.”
“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,” he adds. “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.”
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The report in the European Heart Journal notes that in 2017, the American College of Cardiology added a new category to its 2017 guidelines for high blood pressure, “Stage 1 Hypertension,” defined as 130-139 mmHg/80-89 mmHg, and urged that the condition be treated.
The European Society of Cardiology defines that range as “high normal” blood pressure, with no specific action recommended.
A team led by researchers from the Technical University of Munich and the Helmholtz Zentrum München concludes after a prospective study that treating hypertension patients sooner does not reduce the risk of deadly heart disease and could negatively affect their mental health. The researchers recommend against the U.S. guidelines being adopted in Europe.
“The idea behind the U.S. 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,” explained coauthor Karl-Heinz Ladwig, PhD, who adds that unexpected consequences might be occurring.
Using a population-based cohort, the study team investigated the clinical value of a lower blood pressure (BP) cut-off for stage 1 (S1) hypertension versus the currently established stage 2 (S2) cut-off, ≥140/90 mmHg.
Participants were drawn from the MONICA/KORA prospective study; the sample of 11,603 had a mean age of 47.6 years; 52% were men. Results indicate that implementation of the new S1 cut-off increased the prevalence of hypertension from 34% to 63%, and that only 24% of S2 hypertension patients were under treatment.
Over a decade of follow-up, 370 fatal CVD events were observed, with the adjusted CVD-specific mortality rate per 1,000 persons calculated as 1.61 [95% confidence interval (CI) 1.10–2.25] cases in S2 and 1.07 (95% CI 0.71–1.64) cases in S1 hypertension, compared with normal BP.
While the analysis demonstrated a significant association between S2 and CVD mortality (1.54, 95% CI 1.04–2.28, P = .03), statistical significance for S1 hypertension was not reached (0.93, 95% CI 0.61–1.44, P = .76), researchers report.
At the same time, they note, a significantly higher prevalence of depressed mood was detected in treated patients among S2 participants (47%), compared with nontreated patients (33%).
“The lower BP cut-off substantially increased hypertension prevalence, while capturing a population with lower CVD mortality,” study authors conclude. “Additionally, participants under treatment were more likely to have depressed-mood in comparison to non-treated participants, which might reflect a negative labelling effect.”
The study points out that depression was significantly more common in those taking medication to treat their serious hypertension, with depressive moods reported by about half of all patients versus just one-third of those not receiving treatment.
“We believe that this should be seen as a labeling effect,” Ladwig suggests. “When people are officially labeled as ‘sick’, that has an impact on their mental health.”
“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,” he adds. “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.”
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