Seldom, a study gets so much praise: methodically well done, independent of industry, convincing result, a milestone. The speech is from the study published in November with the exciting name Sprint, performed by the NIH US Health Agency. The authors' conclusion is clear: Doctors can save lives if they lower blood pressure more than previously recommended. Specifically, in the study, one-third fewer heart attacks and stroke and one-fourth fewer deaths were seen in high risk patients, reducing the upper blood pressure to 120 mmHg instead of 140 mmHg.
But despite the clear results, doctors are reluctant to implement the new results. Many have serious objections and are waiting for treatment recommendations from major international professional organizations that are currently reviewing adjustments. "As a rule, it takes at least a year for new findings to be incorporated into guidelines," says Thomas Lüscher, director of the Cardiology Department at Zurich University Hospital. There may be more studies confirming Sprint's results. But one thing is clear to the cardiologist: "The Sprint study will greatly change the treatment of high blood pressure." It is already meaningful to lower blood pressure in patients who tolerate drugs today. "I have already gone on to individuals," says Lüscher.
In Switzerland, one would like to hurry as far as possible. The Board of Hypertoniegesellschaft will in the coming weeks publish an official statement on the Sprint study. "Immediate adjustments to the Swiss guidelines are not planned," says Yves Allemann, president of the association. In practice, however, some would already like clarification. Medics network Medix responded in early January with a first alignment of the internal hypertension guideline. "Our doctors wanted to know how to implement the results of the Sprint study in concrete terms," said Medix President Felix Huber. The Medix Guideline now recommends a greater reduction of blood pressure in individual cases, after weighing the benefits and risks. "Currently, I do not consider a more intensive reduction of all risk patients to be sensible," said Huber.
The restriction is appropriate only because of the large number of victims. According to the Swiss Health Care Survey for 2012, today more than one in two people over 65 is a medical diagnosis of hypertension and swallows appropriate medication, but even the younger ones are often affected so that in Switzerland one of four adult hypertension, about 1.75 million people. You have an increased risk of cardiovascular diseases such as stroke, myocardial infarction and heart failure, but also for chronic kidney disease and dementia. The mortal: sufferers do not feel much of their high blood pressure for a long time.
For Yves Allemann, but the side effects indicate a greater reduction in blood pressure. Because the protective effect of further treatment is appreciated : dizziness, which can lead to falls, increased fatigue or impaired mental performance on the quality of life. Because patients suffer from these adverse effects without feeling any of the blood pressure reduction, they often no longer take medication. "We already have problems implementing the current guidelines," says Allemann. According to studies, this is only the case in about half of all patients with blood pressure.
Even more medication
The situation is exacerbated by the results from The Sprint Study: Often, an additional antihypertensive agent must be taken to lower the value to 120 instead of 140 mmHg. The often elderly patients have problems that they often have to take five or six different drugs regularly. Often, no one knows exactly how the active ingredients affect each other, an additional drug complicates this even more. In addition, most patients do not want more pills.
"In everyday life, it is often a struggle to convince them of necessity," says Allemann, who knows the problem from his own practice. Lead the cardiologist for two and a half years after working for two decades at Inselspital Bern. Undoubtedly, he is now treating all p people with blood pressure above 120 mmHg. "Strictly, the same criteria must be applied as in the Sprint study," he says. The patients included in the whole already took antihypertensive agents, had a blood pressure above 130 mmHg and were, among other things, no diabetic.
Another difficulty in putting the sprint study into practice is blood pressure measurement. "Measurements in the consulting room are 5 to 20 mmHg higher than during the study," says Felix Huber. In the future, he would like to apply the same procedure in Medix methods as in the Sprint study. The blood pressure value would then be the average of several measurements, which single patients decide on themselves – preferably at home. This adjustment is expected to lead to a goal of 120 mmHg for many patients – without increasing the dose.
Created: 28/01/2016, 22:14