For the first time, the results offer a comprehensive overview of blood pressure in Germany over the last twenty years. The Konsortium zur Blutdruckepidemiologie (Consortium for Blood Pressure Epidemiology), founded by DZHK scientists, analysed data from two national health surveys and five regional population-based studies conducted between 1997 and 2012. The blood pressure of men and women has decreased nationwide, most notably among people aged 55 to 74. There were also regional differences: in the Northeast, blood pressure decreased the most compared to the national average. The difference between former East and West Germany observed in previous analyses, according to which blood pressure in the east of Germany was higher than in the west, has hence levelled out.
High blood pressure is identified and treated more often in women
The previously observed gender gap has not narrowed: In women, hypertension is still recognised earlier, treated more often, and thus lowered successfully. In another investigation, PD Dr. Hannelore Neuhauser of the Robert Koch Institute in Berlin and member of the Consortium has found that these gender-differences are especially prominent in the 18 to 54 age group. “These gender-differences are also observed in other countries. They may arise, because younger men rarely see a physician and consequently their blood pressure is measured less frequently. Women, on the other hand, see their gynaecologist regularly, and their blood pressure is also measured”, says Neuhauser. In young men between the age of 25 and 34, a decrease in blood pressure was in fact seen only in the Northeast of Germany. This positive trend was not observed for the country as a whole.
Healthy diet, more exercise, giving up smoking
The scientists also found that blood pressure has been treated increasingly in recent years. They see a possible reason for the improved readings in the increased treatment rates, but also suggest that prevention efforts such as a healthier diet, more exercise and giving up smoking have contributed to the positive development.
The greatest risk factor for global health
Despite recent positive trends, blood pressure is still too high and the total number of people with high blood pressure changed only slightly. The researchers even assume that high blood pressure will be diagnosed more frequently in the future due to the continuously ageing society; and not only in Germany. The WHO has ranked high blood pressure as the greatest risk factor for global health. It is amongst the most important risk factors for dementia, and cardiovascular and renal diseases. Yet high blood pressure could be prevented in many cases and there are many effective treatment options. “Using the example of Northeast Germany, we see how much can be achieved in a decade”, says Neuhauser. “However, there is still room for much improvement, and preventing high blood pressure from occurring in the first place must remain the primary goal.” The threshold for hypertension is currently at 140/90mmHg, but Neuhauser points out that there is a lot of prevention potential in the so-called prehypertension range between 120-140/80-90mmHg. In this range, no drugs are prescribed, but a lifestyle change – in other words, losing excess weight, more exercise, eating a lot of fruit and vegetables, and abstaining from smoking – can make a lot of difference.
Difficult to measure
Population-based studies on high blood pressure that provide information on trends over time or regional differences in Germany are rare. Even though blood pressure is frequently measured in clinical practice, for population comparisons high-precision measurements are needed according to a standardized protocol. “Measuring blood pressure is just as difficult as determining the sea level. Both are subject to strong fluctuations”, compares Neuhauser. “as soon as you climb the stairs or get excited or upset your blood pressure rises.” In the seven analysed studies, study participants were positioned according to a detailed protocol, and the resting periods before the individual blood pressure measurements were identical. Differences between the measurement devices were accounted for using a specific calibration formula. “Such studies on the progression of high blood pressure are complex and costly, but a prerequisite for prevention measures to target the health risk high blood pressure”, states Neuhauser. She and her colleagues emphasize the need for recent blood pressure data in the population over the age of 70 and in young adults. The Consortium will continue its work and will continue to analyse studies on high blood pressure in Germany in the future.
Hypertension in Germany - data from seven population-based epidemiological studies (1994–2012).
Neuhauser H, Diederichs C, Boeing H, Felix SB, Jünger C, Lorbeer R, Meisinger C, Peters A, Völzke H, Weikert C, Wild P, Dörr M: Dtsch Arztebl Int 2016; 113: 809–15.
The persisting gender gap in hypertension management and control in Germany: 1998 and 2008-2011.
Sarganas G, Neuhauser HK. Hypertens Res. 2016 Jun; 39(6): 457-66.
Christine Vollgraf, Public Relations Officer, German Centre for Cardiovascular Research (DZHK), phone: 030 3465 529 02, presse(at)dzhk.de
Hannelore Neuhauser, MD, PHD, MPH, Robert Koch Institute, Department of Epidemiology und Health Monitoring, NeuhauserH(at)rki.de