Current Hypertension Reports

, Volume 15, Issue 6, pp 669–675

Pre-Hypertension: Rationale for Pharmacotherapy

Prevention of Hypertension: Public Health Challenges (P Muntner, Section Editor)

Abstract

Pre-hypertension, defined as blood pressure 120–139/80–89 mmHg, affects ~70 million people in the US. Blood pressures in the upper half of the pre-hypertensive range are linked with roughly threefold greater risk of incident hypertension than normal blood pressure <120/<80 mmHg, with an incidence rate of 8–20 % annually. Blood pressures in the upper half of the pre-hypertensive range also roughly double risk for cardiovascular events, even in the absence of progression to hypertension. Despite excess risk, guidelines recommend lifestyle interventions only for people with pre-hypertension in the absence of diabetes mellitus or clinical cardiovascular or chronic kidney disease. While efficacious, lifestyle changes have limited population effectiveness as Americans are heavier and their nutritional patterns less DASH-like than before DASH was published. Prevalent hypertension is higher in African Americans than Caucasians, but prevalent pre-hypertension is similar. African Americans experience a more rapid transition from pre-hypertension to hypertension than Caucasians with pre-hypertension. Interventions that normalize racial differences in incident hypertension could, over time, improve racial equity in prevalent hypertension and related clinical complications. Individuals with pre-hypertension can be safely treated with antihypertensive medications to significantly reduce incident hypertension. Given the evidence, practical clinical trials in African Americans with pre-hypertension to reduce and eliminate racial disparities in incident hypertension have merit. The results of these trials could provide the foundation for clinical guidelines to reduce racial disparities in prevalent hypertension and associated clinical cardiovascular and renal diseases.

Keywords

Pre-hypertension Incident hypertension Racial differences Metabolic syndrome Cardiovascular risk Pharmacotherapy 

References

Recently published papers of particular interest have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Robinson SC, Brucer M. Range of normal blood pressure: a statistical and clinical study of 11,383 persons. Arch Intern Med. 1939;64:409–44.CrossRefGoogle Scholar
  2. 2.
    Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–52.PubMedCrossRefGoogle Scholar
  3. 3.
    Egan BM, Julius S. Prehypertension: risk stratification and management considerations. Curr Hypertens Rep. 2008;10:359–66.PubMedCrossRefGoogle Scholar
  4. 4.
    Kshirsagar AV, Carpenter M, Bang H, Wyatt SB, Colindres RE. Blood pressure usually considered normal is associated with an elevated risk of cardiovascular disease. Am J Med. 2006;119:133–41.PubMedCrossRefGoogle Scholar
  5. 5.
    •• Howard G, Lackland DT, Kleindorfer DO, Kissela BM, Moy CS, Judd SE, Safford MM, Cushman M, Glasser SP, Howard VJ. Racial differences in the impact of elevated systolic blood pressure on stroke risk. JAMA Intern Med. 2013;173(1):46–51. This original study documents that elevations of systolic blood pressure increase stroke risk more in black than white individuals. The study used a population-based sample from the US with oversampling in Southeast States. PubMedCrossRefGoogle Scholar
  6. 6.
    Wang Y, Wan QJ. The prevalence of prehypertension and hypertension among US adults according to the new Joint National Committee Guidelines. Arch Int Med. 2004;164:2126–34.CrossRefGoogle Scholar
  7. 7.
    • Selassie A, Wagner CS, Laken MA, Ferguson ML, Ferdinand KC, Egan BM. Progression for pre-hypertension to hypertension is accelerated in African Americans. Hypertension. 2011;58:579–587. At primary care sites in the Southeast U., 50 % of African Americans progressed from pre-hypertension to hypertension in 1.7 years as compared to 2.7 years in whites. Racial differences in incident hypertension persisted after multivariable adjustment. PubMedCrossRefGoogle Scholar
  8. 8.
    Ogden LG, He J, Lydick E, Whelton PK. Long-term absolute benefit of lowering blood pressure in hypertensive patients according to the JNC VI risk stratification. Hypertension. 2000;35:539–43.PubMedCrossRefGoogle Scholar
  9. 9.
    Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH collaborative research group. N Engl J Med. 1997;336:1117–24.PubMedCrossRefGoogle Scholar
  10. 10.
    Lasser V, Raczynski J, Stevens V, Mattfeldt-Beman M, Kumanyika S, Evans M, et al. Trials of hypertension prevention, Phase II: structure and content of the weight loss and dietary sodium reduction interventions. Ann Epidemiol. 1995;5:156–64.PubMedCrossRefGoogle Scholar
  11. 11.
    Kumanyika S, Cook N, Cutler J, Belden L, Brewer A, Cohen J, et al. Sodium reduction for hypertension prevention in overweight adults: further results from the trials of hypertension prevention phase II. J Hum Hypertens. 2005;19:3–45.CrossRefGoogle Scholar
  12. 12.
    Seibenhofer A, Berghold J, Waltering A, Hemkens L, Semlitsch T, Pachler C, Strametz R, Horvath K. Long-term effects of weight-reducing diets in hypertensive patients. Cochrane Database System Rev. 2011, Issue 9. Art. No.:CD008274. doi:10.1002/14651858.CD008274.pub2
  13. 13.
    Esposito J, Giugliano D. Mediterranean diet and the metabolic syndrome: the end of the beginning. Metab Syndr Relat Disord. 2010;8:197–200.PubMedCrossRefGoogle Scholar
  14. 14.
    Usinger L, Reimer C, Ibsen H. Fermented milk for hypertension. Cochrane Database System Rev 2012, Issue 4. Art. No.:CD008118. doi:10.1002/14651858.CD008118.pub2
  15. 15.
    Lopes HF, Martin KL, Nashar K, Morrow JD, Goodfriend TL, Egan BM. DASH diet lowers blood pressure and lipid-induced oxidative stress in obesity. Hypertension. 2003;41:422–30.PubMedCrossRefGoogle Scholar
  16. 16.
    Al-Solaiman Y, Jesri A, Mountford WK, Lackland DT, Zhao Y, Egan BM. DASH lowers blood pressure in obese hypertensives beyond potassium, magnesium and fibre. J Hum Hypertens. 2010;24:237–46.PubMedCrossRefGoogle Scholar
  17. 17.
    Al-Solaiman Y, Jesri A, Zhao Y, Morrow JD, Egan BM. Low-soidum DASH reduces oxidative stress and improves vascular function in salt-sensitive humans. J Hum Hypertens. 2009;23:826–35.PubMedCrossRefGoogle Scholar
  18. 18.
    Aizawa K, Kevin Shoemaker JK, Tom J, Overend TJ, Petrella RJ. Effects of lifestyle modification on central artery stiffness in metabolic syndrome subjects with pre-hypertension and/or pre-diabetes. Diab Res Clin Prac. 2009;8:249–56.CrossRefGoogle Scholar
  19. 19.
    Mellen PB, Gao SK, Vitolins MZ, Goff Jr DC. Deteriorating dietary habits among adults with hypertension: DASH dietary accordance, NHANES 1988–1994 and 1999–2004. Arch Intern Med. 2008;168:308–14.PubMedCrossRefGoogle Scholar
  20. 20.
    Ford ES, Zhao G, Li C, Pearson WS, Mokdad AH. Trends in obesity and abdominal obesity among hypertensive and nonhypertensive adults in the United States. Am J Hypertens. 2008;21:1124–8.PubMedCrossRefGoogle Scholar
  21. 21.
    The Trial of Hypertension Prevention Collaborative Research Group. Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The trials of hypertension prevention, phase II. Arch Intern Med. 1997;157:657–67.CrossRefGoogle Scholar
  22. 22.
    Julius S, Nesbitt SD, Egan BM, Weber MA, Michelson EL, Kaciroti N, et al. Feasibility of treating prehypertension with an angiotensin-receptor blocker. N Engl J Med. 2006;354:1685–97.PubMedCrossRefGoogle Scholar
  23. 23.
    Hartley L, Igbinedion E, Holmes J, Flowers N, Thorogood M, Clarke A, Stranges S, Hooper L, Rees K. Increased consumption of fruit and vegetables for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.:CD009874. doi:10.1002/14651858.CD009874.pub2
  24. 24.
    Desroches S, Lapointe A, Ratte S, Gravel K, Legare F, Turcotte S. Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.:CDC008722. doi:10.1002/14651858.CD008722.pub2
  25. 25.
    Bopp M, Wilcox S, Laken M, Hooker S, et al. 8 steps to fitness: a faith-based, behavior change physical activity intervention for African Americans. J Physical Activity. 2009;6:568–77.Google Scholar
  26. 26.
    Tussing-Humphreys L, Fitzgibbon M, Kong A, Odoms-Young A. Weight loss maintenance in African American women: A systematic review of the behavioral lifestyle intervention literature. J Obes. 2013. Article ID 437369, 31 pages. doi:10.1155/2013/437369
  27. 27.
    Stephan Lüders S, Schrader J, Berger J, Unger T, Zidek W, Böhm M, et al. The PHARAO study: prevention of hypertension with the angiotensin-converting enzyme inhibitor ramipril in patients with high-normal blood pressure—a prospective, randomized, controlled prevention trial of the German Hypertension League. J Hypertension. 2008;26:1487–96.CrossRefGoogle Scholar
  28. 28.
    Fuchs FD, Fuchs SC, Moreira LB, Gus M, Nóbrega AC, Poli-de-Figueiredo CE, et al. Prevention of hypertension in patients with pre-hypertension: protocol for the PREVER-prevention trial. Trials. 2011;12:65. doi:10.1186/1745-6215-12-65.PubMedCrossRefGoogle Scholar
  29. 29.
    •• Thompson AM, Hu T, Eshelbrenner CL, Reynolds K, He J, Bazzano LA. Antihypertensive treatment and secondary prevention of cardiovascular disease events among persons without hypertension. A meta-analysis. JAMA. 2011;305(9):913–922. This meta-analysis of non-hypertensive subjects among patients with various clinical cardiovascular diseases found that several different classes of antihypertensive medications were useful in secondary prevention of recurrent cardiovascular events. PubMedCrossRefGoogle Scholar
  30. 30.
    • Sipahi I, Swaminathan A, Natesan V, Debanne SM, Simon DI, Fang JC. Effect of antihypertensive therapy on incident stroke in cohorts with prehypertensive blood pressure levels. A meta-analysis of randomized controlled trials. Stroke. 2012;43: 432–440. A meta-analytic analysis of completed secondary prevention studies in pre-hypertensive patients with clinical cardiovascular disease showed that antihypertensive therapy significantly reduced incident stroke. PubMedCrossRefGoogle Scholar
  31. 31.
    Kshirsagar AV, Carpenter M, Bang J, et al. Blood pressure usually considered normal is associated with an elevated risk of cardiovascular disease. Am J Med. 2006;119:133–41.PubMedCrossRefGoogle Scholar
  32. 32.
    Vasan RS, Larson MG, Leip EP, et al. Impact of high normal blood pressure on the risk of cardiovascular disease. N Engl J Med. 2001;345:1291–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Liszka HA, Mainous AG, King DE, et al. Prehypertension and cardiovascular morbidity. Ann Fam Med. 2005;3:294–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Zhang Y, Lee ET, Devereux RB, et al. Prehypertension, diabetes, and cardiovascular disease risk in a population-based sample: the Strong Heart Study. Hypertension. 2006;47:410–4.PubMedCrossRefGoogle Scholar
  35. 35.
    Hsia J, Margolis KL, Eaton CB, et al. Prehypertension and cardiovascular disease risk in the Women’s Health Initiative. Circulation. 2007;115:855–60.PubMedCrossRefGoogle Scholar
  36. 36.
    Gu D, Chen J, Wu X, Duan X, Jones DW, Huang J-f, et al. Prehypertension and risk of cardiovascular disease in Chinese adults. J Hypertension. 2009;27:721–9.CrossRefGoogle Scholar
  37. 37.
    Neaton JD, Kuller L, Stamler J, et al. Impact of systolic and diastolic blood pressure on cardiovascular mortality. In: Laragh JH, Brenner BM, editors. Hypertension, pathophysiology, diagnosis, and management. 2nd ed. New York: Raven Press, Ltd; 1995.Google Scholar
  38. 38.
    Tsai SP, Wen CP, Chan HT, et al. The effects of predisease risk factors within metabolic syndrome on all-cause and cardiovascular disease mortality. Diabetes Res Clin Pract. 2008;82:148–56.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.School of Medicine Greenville, Greenville Health System, Care Coordination InstituteUniversity of South CarolinaGreenvilleUSA
  2. 2.Medical University of South CarolinaCharlestonUSA
  3. 3.Care Coordination InstituteUniversity of South Carolina School of Medicine – GreenvilleGreenvilleUSA

Personalised recommendations