US blood pressure guidelines, telehealth for cancer treatment, future of medical research, welcoming the wellderly

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What are the new US blood‑pressure guidelines and why are they controversial?

Unknown 0:01

This is an ABC podcast.

Norman Swan 0:06

Hello and welcome to this week's health report with me, Norman Swan. Today, will medical research in Australia deliver the outcomes we expect it to? And what do we expect? A world leading transformation in cancer care and treatment in northern Queensland. And you've probably never heard of it. a fascinating approach to searching for cancer genes by looking at well people as opposed to sick ones, and how America hasn't necessarily made it great when it comes to your blood pressure. Last year, the American College of Cardiology and the American Heart Association controversially lowered the level of blood pressure at which doctors diagnose hypertension or high blood pressure. As opposed to 140 over 90, in theory, an American can qualify as hypertensive at 130 over 80.

Norman Swan 0:50

It was controversial because it could mean that up to one in two adults would be classified as hypertensive at enormous cost. The question is, would the cost in medications be offset by preventing deaths from heart attacks and strokes? That's what a group of German researchers sought to answer. And on the line from Munich is Serian Atasoy. Welcome.

Sarian Atasoy 1:10

Hello, thank you for having me.

Norman Swan 1:11

Now, this didn't come out of nowhere, this idea to lower the level. And in fact, it was a trial we reported on, on the health report, the SPRINT trial, which suggested if you've got people at high risk of heart attacks and you lower their blood pressure down really low, they do benefit.

Sarian Atasoy 1:26

Yeah, exactly. So they had two groups of blood pressure lowering below a systolic blood pressure of 120 and below 140. Just to explain, the

Norman Swan 1:37

systolic is the top number, the diastolic is

Sarian Atasoy 1:40

the bottom number. Yeah, exactly. This study was focused on systolic blood pressure. And they showed that if you decrease systolic blood pressure below 120, the participants had 43% less risk of cardiovascular events.

Norman Swan 1:58

And that's the basis on which they lowered the level in

Sarian Atasoy 2:00

the

Norman Swan 2:00

United States. But this wasn't

Sarian Atasoy 2:02

Norman Swan 2:03

generally healthy group. This was people at risk.

Sarian Atasoy 2:06

Exactly. They were over 50 years old and they all already had hypertension. No, actually, they all already had a systolic blood pressure of 130 or more and an increased risk of cardiovascular disease.

Norman Swan 2:18

And that's not the group of people you looked at because you looked at whether you could generalize from that group to the general population.

How did the German researchers test the impact of lowering hypertension thresholds?

Sarian Atasoy 2:24

Yeah, exactly. So we implemented this American hypertension guideline to a healthy population in Germany. And we found that... Was it just before you give

Norman Swan 2:39

away the punchline here? So they were aged, what, 24 to 17. There was about 11,000 of them. Is that right?

Sarian Atasoy 2:45

Yeah, exactly. And

Norman Swan 2:48

you've been

Sarian Atasoy 2:49

following them

Norman Swan 2:49

for some years. So you didn't, in fact, treat their blood pressure. You were looking to see how well they fared or badly they fared with a blood pressure at that level.

Sarian Atasoy 2:56

Yes, this was an observational study. So we had over 11,000 people at baseline when we followed them for 10 years. And we wanted to see how... implementing this hypertension prevalence would affect the outcomes. So firstly, the prevalence increased from 34% of hypertension to 63%. 63?

Norman Swan 3:17

Gosh.

Sarian Atasoy 3:20

So it's more than one in two. Exactly. Well, in this study. And so we wanted to know whether this huge... increase in the range of hypertension was medically justified given the burden that it would add to the healthcare system.

Unknown 3:38

And

Sarian Atasoy 3:38

we found that in comparison to participants without hypertension, participants with what is called stage two hypertension, so systolic blood pressure over 140 and diastolic blood pressure over 90, they had a 54% increased risk of cardiovascular death. And this is taking into account all other risk factors. Yeah, exactly. Taking into account other risk factors such as smoking, drinking, diabetes, etc.,

Norman Swan 4:10

So you confirmed then if you had high blood pressure or hypertension as per the European and I think Australian guidelines, then you are indeed at 50% added risk of dying of a heart attack or stroke over 10 years.

Sarian Atasoy 4:24

Exactly.

Norman Swan 4:25

What did you

Sarian Atasoy 4:26

find for the

Norman Swan 4:26

group who were between 130 over 80 and 140 on 90?

Sarian Atasoy 4:31

So we did not find a significant increase of cardiovascular mortality in this group.