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High blood pressure or high blood pressure is a common medical problem. It is controversial in an episodic way, as one or the other guideline continues to reduce the diagnostic criteria for initiation of treatment, thus creating an increasingly large market for physicians and pharmaceuticals to be treated. One of the reasons we treat high blood pressure is that it forces the heart to work harder. It takes more muscle strength to exert pressure from 150 to 120. And working harder for an aging heart is intuitively a bad idea. On the other hand, when the arteries are partially clogged, higher pressure may be needed for the blood to circulate wherever it needs to go.
A study published in the European Heart Journal comes to a startling conclusion: control of blood pressure is not always good for you; In fact, it can increase your chances of dying. The study involved Germans aged 70 years or older participating in a long-term renal function study – dialysis or transplant patients were excluded. About 80% of participants were treated for hypertension and then stratified into two groups; those whose blood pressure is "normalized", for example 140/90 and who respond to acceptable recommendations, let's call them well controlled. The second group had higher blood pressure readings, although the drugs did not follow our recommendations, so call them less controlled. The average decline was six years.
- Well-controlled patients had a 25% greater chance of all-cause mortality than those with less controlled hypertension.
But if you look at the differences between the two groups, well-controlled "normalized" people are more likely to have had a heart attack, so maybe that played a role. Researchers conducted further badyzes to isolate cardiovascular patients and older patients. From a hacking perspective, this badysis was part of the study design and was not based on results.
- In the absence of previous cardiovascular events, the incidence of all-cause mortality was the same in well-controlled and less-controlled patients.
- Once stratified by age for patients aged 70 to 79, again, well-controlled and less-controlled patients had the same incidence of all-cause mortality.
If the degree of blood pressure control did not help or hurt these groups, who showed any advantages or disadvantages?
- If there had been previous cardiovascular events, patients with well-controlled blood pressure control showed a 56% increase in all-cause mortality.
- Similarly, in people over 80, well-controlled blood pressure was badociated with a 34% increase in all-cause mortality compared to the less controlled cohort.
Here is a graphical representation, with a U or J curve, which means that the mortality increases when the blood pressure is too low and too high.
This is a form consistent with the idea that blood pressure changes self-regulation to find a "gold buckle" range, increasing the pressure to increase blood flow to the organs and to compensate for the loss of function – as for the somewhat clogged hoses, perhaps a slightly higher pressure.
Other short-term studies in the elderly suggest that a reduction in blood pressure to 120 results in better results, so that a definite understanding eludes us. But if we are to practice personalized medicine, we must recognize that the general recommendations are inadequate and we may need to realize that there are many subgroups all requiring different care. For such a widespread and widespread disease, high blood pressure still has many lessons to teach us about standardization, as well as a little more humble and a little less eminent in our guidelines and statements.
Source: Blood Pressure and Mortality Risk Control in a Cohort of Older Adults: Berlin Initiative Study, European Heart Journal, DOI: 10.1093 / eurheartj / ehz071
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