Coronary artery disease correlates closely with arterial hypertension. Therefore, to prevent damage to the left ventricular myocardium or the risk of stroke, blood pressure should be lowered. Only how far?
CHD and arterial hypertension are closely associated and may result in left ventricular myocardial damage. In addition, inadequately treated high blood pressure can also significantly increase the risk of stroke and kidney failure. The target is therefore a blood pressure below 140 mmHg/90 mmHg. However, many patients do not reach this value. In this context, one study found that patients with moderate cardiovascular risk in particular benefit significantly from blood pressure values below 130 mmHg systolic [2]. Reason enough for the American professional societies to adapt their guidelines accordingly. Since 2017, the American College of Cardiology guidelines have included an additional hypertension category, Stage 1 Hypertension. Accordingly, patients should already be treated at levels of 130-139 mmHg/80-89 mmHg [3].
However, not all experts share this attitude. Germany and Europe in particular are critical of the implementation of such low values. One reason is the particular patient profile of the study. High-risk patients with diabetes or a history of stroke were not studied. There is preliminary evidence that there may be a resurgence of cardiovascular events in certain patients when pressure falls below 120 mmHg.
The main point of criticism, however, lies in the blood pressure measurement itself. The measurements were carried out unattended, so that the “white coat effect” was absent. Therefore, incorrect, higher measured values may occur in everyday practice. Prof. Schunkert, Munich, also warns patients with CHD to be particularly cautious: “Too drastic a reduction with diastolic values below 60 mmHg can be problematic for patients with CHD because blood flow to the coronary vessels can be jeopardized, especially if constrictions are still present.” [4].
Literature:
- Busch M, Kuhnert R: Journal of Health Monitoring 2017; 2(1): 64-69.
- The SPRINT Research Group: N Engl J Med. 2015; 373: 2103-2116.
- Atasoy S, et al: European Heart Journal 2018.
- www.herzstiftung.de/sprint-studie-blutdruck-wie-tief-senken.html (last access: 01/26/2019)
CARDIOVASC 2019; 18(1): 32
