Current Hypertension Reports

, Volume 9, Issue 3, pp 202–205 | Cite as

Should the results of TROPHY affect the JNC 7 definition of prehypertension?

Article

Abstract

In the Trial of Preventing Hypertension (TROPHY), volunteers with “high normal blood pressure” were randomized to 4 years of placebo (n = 381) or 2 years of 16 mg/d of candesartan (n = 391) followed by 2 years of placebo. At 2 years, there was a 26.8% absolute and a 66.3% relative risk reduction (P < 0.0001) of hypertension in the candesartan group. At study end, the former candesartan group had a 9.8% absolute and a 15.6% relative risk reduction (P < 0.007) of hypertension. The treatment was well tolerated. The Seventh Joint National Committee (JNC 7) changed the nomenclature from “high normal blood pressure” to “prehypertension” and widened the range to 120 to 139 and/or 80 to 89 mm Hg. Our results support the term “prehypertension” only for the 130 to 139 and/or 85 to 89 mm Hg group; in 4 years two thirds of the placebo group developed hypertension. We suggest stratifying the JNC classification into “prehypertension” (130–139 and/or 85–89 mm Hg) and “high normal blood pressure” (120–129 and/or 80–84 mm Hg). By the present JNC definition, only one quarter of adult men have normal blood pressure. Removing the disease label from another 28% would appropriately focus attention on high-risk prehypertension.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Julius S, Nesbitt S, Egan B, et al., for the TROPHY study group: Trial of preventing hypertension: design and 2-year progress report. Hypertension 2004, 44:146–151.PubMedCrossRefGoogle Scholar
  2. 2.
    Julius S, Nesbitt SD, Egan BM, et al., for the Trial of Preventing Hypertension (TROPHY) Study Investigators: Feasibility of treating prehypertension with an angiotensin-receptor blocker. N Engl J Med 2006, 354:1685–1697.PubMedCrossRefGoogle Scholar
  3. 3.
    Julius S, Schork MA: Borderline hypertension: a critical review. J Chronic Dis 1971, 23:723–754.PubMedCrossRefGoogle Scholar
  4. 4.
    Julius S, Jamerson K, Mejia A, et al.: The association of borderline hypertension with target organ changes and higher coronary risk. Tecumseh Blood Pressure Study. JAMA 1990, 264:354–358.PubMedCrossRefGoogle Scholar
  5. 5.
    Frohlich ED: Detection, evaluation, and treatment of hypertension: JNC-5 (Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure). Heart Dis Stroke 1993, 2:459–460.PubMedGoogle Scholar
  6. 6.
    Chobanian AV, Bakris GL, Black HR, et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003, 289:2560–2572.PubMedCrossRefGoogle Scholar
  7. 7.
    Wright CE, Angus JA: Enhanced total peripheral vascular responsiveness in hypertension accords with the amplifier hypothesis. J Hypertens 1999, 17:1687–1696.PubMedCrossRefGoogle Scholar
  8. 8.
    Kelm M: The L-arginine-nitric oxide pathway in hypertension. Curr Hypertens Rep 2003, 5:80–86.PubMedGoogle Scholar
  9. 9.
    Nakaya H, Sasamura H, Hayashi M, Saruta T: Temporary treatment of prepubescent rats with angiotensin inhibitors suppresses the development of hypertensive nephrosclerosis. J Am Soc Nephrol 2001, 12:659–666.PubMedGoogle Scholar
  10. 10.
    Schiffrin EL, Deng LY, Larochelle P: Progressive improvement in the structure of resistance arteries of hypertensive patients after 2 years of treatment with an angiotensin I-converting enzyme inhibitor: comparison with effects of a β-blocker. Am J Hypertens 1995, 8:229–236.PubMedCrossRefGoogle Scholar
  11. 11.
    Schiffrin EL, Deng LY: Comparison of effects of angiotensin I-converting enzyme inhibition and beta-blockade for 2 years on function of small arteries from hypertensive patients. Hypertension 1995, 25:699–703.PubMedGoogle Scholar
  12. 12.
    Vasan RS, Larson MG, Leip EP, et al.: Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet 2001, 358:1682–1686.PubMedCrossRefGoogle Scholar
  13. 13.
    Neaton JD, Kuller L, Stamler J, Wentworth DN: Impact of systolic and diastolic blood pressure on cardiovascular mortality. In Hypertension: Pathophysiology, Diagnosis and Management, vol 1, edn 2. Edited by Laragh JH, Brenner BM. New York: Raven Press; 1995:127–144.Google Scholar

Copyright information

© Current Medicine Group LLC 2007

Authors and Affiliations

  1. 1.Internal Medicine and Physiology, Division of Cardiovascular MedicineUniversity of MichiganAnn ArborUSA

Personalised recommendations