Fifteen million Italians, that is 30-40 percent of adults. Many are our compatriots with high blood pressure, a problem that causes 280 thousand deaths every year in our country alone: the experts of the Italian Society of Arterial Hypertension (SIIA) recalled. Also trying to clarify the strategies to fight it: it is not always appropriate, for example, to insist on lowering the pressure so much with drugs. A study published in The Lancet, born from the review of two different studies that have overall followed almost 31 thousand patients from 40 countries for just under five years: all subject to very high cardiovascular risk because they are often already victims of heart attacks or strokes, in some cases not even hypertensive.
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Don’t lower it too much
Undergoing therapy to lower blood pressure with the intention of keeping it as low as possible, not everyone benefited greatly from “intensive” treatment: the therapy reduced the likelihood of experiencing a cardiovascular event, but the danger arose when it fell below 120 millimeters of mercury for the maximum and 70 for the minimum. Gianfranco Parati, president of SIIA, is not surprised, observing: “We are talking about patients already suffering from cardiovascular diseases, with very rigid arteries and rich in calcium deposits: people with a poor ability to self-regulate blood flow and adapt vessels under different conditions to keep it constant. In these subjects, an excessive drop in pressure is not compensated, the system is like a “plaster cast” and there is a risk of a dangerous reduction in organ perfusion which can lead to serious consequences ». A young person (the participants in the studies analyzed were all over 55) and in greater health would therefore not suffer the same consequences from a considerable pressure drop obtained with drugs.
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Fewer cases of heart attack and stroke
Which “number” should we aim for to be calm? Parati sought to answer this and other key questions about high blood pressure with a series of ten meta-analyzes published in the Journal of Hypertension, conducted by re-analyzing the data of countless studies; evaluating hypertensive patients but without heart attack, heart failure or other serious pathologies, it has been seen for example that the therapy offers cardiovascular advantages when it falls below 150, 140 but also 130 in general. “The benefits, however, are progressively less the lower the pressure level is reached: in uncomplicated hypertension, falling below 130 is therefore not dangerous, but the number of cardiovascular events that can be avoided decreases – specifies the expert -. Those with the highest blood pressure have a very high probability of heart attacks and strokes, therefore lowering it “cuts” a more consistent number of cases than what happens in those who start from an initial level of hypertension, and therefore risk of events, a little ‘more contained: in percentage terms the decrease in danger is similar in both groups, but by intervening on those who are more hypertensive, a greater number of cases of heart attack, stroke, death are “spared” ». On the basis of all this, many have thought, in the past, that it was more appropriate to focus on the treatment of high-risk patients, guaranteeing the therapies an optimal cost / benefit ratio; However, the meta-analyzes of Parati have made it possible to discover more, changing the panorama considerably.
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“The sooner, the better”
“If it is true that the greater the initial risk, the more the absolute number of events that a patient can develop is reduced, it is equally certain that the cardiovascular risk that remains is higher, the so-called residual risk that we will no longer be able to remove. because it derives from the irreversible damage caused by hypertension during all the time in which it was not kept under control: if the arteries are hardened by calcium deposits, we cannot go back and “clean them” – explains Parati -. This is why in the treatment of hypertension the motto today should not be “the lower the better”, as also demonstrated by the latest data on patients at very high risk of Lancet, rather, “the sooner, the better”: real success in prevention occurs only if we intervene when the organ damage is not there or is still reversible. “Concentrating on lowering the pressure with aggressive therapies – he concludes – only when it is already very high at the start and one is exposed to a high risk of cardiovascular events means only plugging the leaks: of course we will have a benefit, but we will never return to normal and we will have in fact failed to protect the patient, because the residual risk of complications will remain high and will cause heart attacks, strokes, deaths. We need to start treating hypertension when it hasn’t caused too much trouble yet. “
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Rules to prevent it
There is also an app to understand if you are at high cardiovascular risk, keep blood pressure under control, know all the ways to reduce it and improve your lifestyle, manage therapies and visits: it is ESH Care, created and now renewed by SIIA in collaboration with the European Society of Hypertension, available free for Android and iOS. The goal is to increase the awareness of Italians towards hypertension, which unfortunately is increasingly widespread because few follow the rules to prevent it: it would be enough to keep weight and salt intake under control, limit alcohol and do a ‘ regular physical activity to greatly reduce the risk of high blood pressure. The diagnosis is also fundamental, possible only if the pressure is measured regularly by your family doctor: it should be done once a year from school age (especially if the child is chubby).
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11 August 2020 (change 11 August 2020 | 10:21)
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