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People with hypertension who do not treat properly have a risk of a fatal heart attack more than five times higher than those who retain therapy. In Europe and the USA, the number of such patients is increasing. People with elevated blood pressure of 140/90 mm Hg are also at risk.
An international team of scientists led by Dr. Kimmo Herttua from the University of Helsinki investigated the most commonly used therapy systems for patients with hypertension. Researchers have made a very significant discovery regarding the treatment of people with this type of disorder.
Patients with hypertension who take medication inappropriately, such as skipping the dosages prescribed by their doctor, who heal in their own way, or who abandon medication during its course, are at risk of developing a fatal heart attack. The risk is four times higher than in normally treated patients in the second year from the first prescription of antihypertensive drugs and three times higher in the 10th year after the first antihypertensive drugs.
According to a study of 73 hypertensive patients across Europe, the risk is on average 527 times higher than in patients who are treated continuously.
The threat of a fatal heart attack is rising
Patients who do not take medications as prescribed by their doctor also risk hospitalization due to arrhythmias and heart attacks. The risk of hospitalization is 2,7 times higher for them in the second year after prescribing the first drugs and 1,7 times higher in the 10 year after the first drugs. In the year they were admitted to the hospital, the risk of death in this group is about twice as high as in patients on permanent therapy who also enter the hospital after a heart attack.
These studies quite accurately show how important it is for patients with hypertension to follow the doctor’s instructions and take medication according to his instructions in order to minimize the risk of complications, mainly severe and fatal heart attacks. Patients who are poorly treated even in the 10th year after the diagnosis of the disease show a greater risk of such an attack. We have clearly identified the presence of dose-response interactions, and worse, the link between treatment discontinuation and an increased risk of a fatal attack, Dr. Kimmo Herttua said in a statement for Science.
The team of researchers used data from the UK and Finland on sick people, their medications, hospital referrals and deaths, and their causes in their experiments. The data from the Finnish insurance system proved to be the most complete, which made it possible to state from the interview whether patients were taking their prescribed medications.
Analyzing the data collected from January 1, 1995 to December 31, 2007, researchers after examining 73 people over 527 with diagnosed hypertension, recorded 30 referrals to the hospital as a result of a heart attack and 24 deaths as a result of such an attack.
The researchers then listed prescriptions and dosages, determined how the patients took the prescribed drugs, and divided them into three groups. The first group included patients who adhered to the imposed treatment regimen – they took drugs for 80%. or more of a scheduled treatment period, understood in constant therapy as the period between two visits to the physician. In turn, those who did not comply were those who took drugs for 30-80 percent. scheduled treatment duration. The third group consisted of patients who had stopped taking their medications completely, taking them for less than 30%. the prescribed treatment duration.
Take medications only as directed by a doctor
According to the researchers, the method used allowed for the determination of the degree of risk for patients who were receiving treatment properly, who did not adhere to the treatment regimen, and for those who had abandoned the treatment. In the year of heart attack, patients in the non-adhering and discontinued groups had a 1,7-fold and 2,6-fold higher risk of another heart attack, respectively, than in the group receiving proper treatment. The risk that such an attack would be fatal was 3,6 times and 8 times higher than in the group of patients treated properly.
We analyzed the relationship between adherence to treatment regimen and the frequency of heart attacks and year-on-year fatal attacks. For example, if a person who died from a heart attack belonged to a group who dropped out of treatment in the fourth year of a fatal attack and was receiving treatment a year earlier, then their risk of dying increased significantly in the year they dropped out of treatment, he said. Dr. Herttua.
Researchers also considered the risk of a fatal heart attack, linking it to different types of treatments and the types of drugs used in them. Thus, the combination of renin-angiotensin (drugs such as Enalapril, Lisinopril, Candesartan and Losartan) with duiretics or beta-blockers, in case of abandonment, carried the highest risk, resulting in a 7,5-fold higher risk of death and approximately 4-fold higher risk of death. higher risk of hospitalization in the event of an attack compared to patients who continued to use these drugs.
Scientists believe that the results of the analysis show a very strong and correct relationship between the discontinuation of treatment for hypertension and the occurrence of fatal heart attacks, due to the large amount of complete data, including information about the age, weight, build of the patient, addictions such as smoking, alcohol use and even data from daily blood pressure diaries, if the patient has kept them.
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Hypertension – a disease of the XNUMXst century
Meanwhile, in the light of the latest research by researchers from the USA and the European Union, hypertension in North America and Europe is becoming a really big problem.
A team of scientists from Harvard Medical School has conducted a study of hypertension on 350 at-risk patients of all ages and periods of the disease. As researchers found, an increase in waist circumference and rapidly growing body weight are common determinants of this disease, with the risk of a fatal heart attack, coronary heart disease or kidney dysfunction.
For young adults (20 years of age) and slightly older, the blood pressure is usually normalized to 120/80 mm Hg. However, in children the pressure may be higher depending on gender, age and height. In the case of higher values in children and adolescents, hypertension is not immediately shown, because the readings must be higher than acceptable for their age and constitution, during three measurements taken at a certain time interval.
The team of researchers compared blood pressure values in 3200 children and younger adolescents aged 8-17 tested in the National Health and Nutrition Examination Survey (NHANES) III in 1988-1994 and in 1999-2008. Age, gender, race and ethnicity, waist circumference and daily sodium intake were taken into account.
By comparison, the tendency for blood pressure to rise was higher in boys than in girls, but unit increases in blood pressure were higher in girls. In NHANES IV, weight gain was seen in all adolescents, with the girls tested in this study having a significantly larger waist circumference. In the case of NAHNES IV, 72% were recorded. an increase in the number of adolescents with high blood pressure compared to the previous study. Children who had the largest waist circumference and weight also had increased blood pressure.
There is also a risk of overusing foods or drinks containing sodium. In the group of children with the highest sodium intake, the risk of high blood pressure was 36 percent higher. In NHANES III and NHANES IV, the daily dose of sodium in 80%. children was 2300 mg, but in NHANES IV the group increased to 3450 mg. Currently, the daily dose of sodium reaching the body of an American adult is 3400 mg. The American Heart Association states that the dose must be less than 1500 mg to protect against heart disease. Over 60 percent the daily amount of sodium comes from processed foods bought in a store and 25 percent. from restaurant dishes, usually fast food.
Similar are the results of a study for Europe covering the period 1988-2010, conducted by an international research team led by Dr. Diana Bonderman from MedUni Vienna. According to the researchers participating in the study, in 2010 the number of overweight teenagers with high blood pressure was twice as high as in 1988. European teens consume slightly less sodium than American ones – about 2800 mg – but sources are the same, with about 66 percent. comes from processed foods, and about 20 percent. from restaurants and fast food. According to European scientists, such sodium consumption and the obesity epidemic threaten widespread hypertension in young people in about a decade and the need to introduce directives to tighten technological regimes for the use of sodium in food processing by the European Union in the next few years.
Older people risk less
Research by a team of Iranian scientists from the Prevention of Metabolic Disorders Research Center in Tehran Dobre contained news for the elderly.
Researchers have been researching for over 9 years, assessing the risk of different blood pressure values in a group of 6273 patients over 30 years of age. According to the results of their research, elevated blood pressure, with values slightly above normal, reduces the risk of acute ischemic heart disease and coronary artery disease.
The risk of developing these diseases is higher in the same group than in the group of people with lower blood pressure, for patients aged 30-60 years. However, the risk of coronary heart disease and coronary artery disease episodes is generally higher in the high blood pressure group than in the normal pressure group. Elevated blood pressure was defined by Iranian physicians as exceeding the values of 140/90 mm Hg.
Treatment of such elevated blood pressure with even low doses of patient matched antihypertensive drugs has been found to generally abolish the risk of acute episodes of ischemic heart disease and coronary artery disease. As Dr. F. Hadaegh said, the most important group of people with high blood pressure in terms of prevention and treatment are middle-aged patients. In this group, there is both the best chance of regulating the blood pressure correctly, e.g. by introducing a healthy lifestyle, reducing salt intake, introducing low doses of antihypertensive drugs, and the risk of sudden onset of disease episodes if treatment is discontinued or an unhealthy lifestyle.
Tekst: Marek Mejssner