Current Cardiovascular Risk Reports

, Volume 1, Issue 3, pp 188–197 | Cite as

Prehypertension: Progression to hypertension and management considerations



Prehypertension is a designation used by the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure to describe untreated adults with blood pressure of 120 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic. As the term implies, prehypertension frequently progresses to hypertension, though weight loss, exercise, and dietary changes can lower blood pressure and reduce the chance of progression to hypertension. Prehypertension often occurs along with other cardiovascular risk factors, such as dyslipidemia and impaired glucose metabolism. Prehypertension also carries independent cardiovascular risk. Recent clinical trials indicate that drug therapy should be considered for stable patients with prehypertension at high risk for cardiovascular disease or stroke. Whether using antihypertensive medication in lower risk persons with prehypertension is advantageous is not known.


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References and Recommended Reading

  1. 1.
    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
  2. 2.
    The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997, 157:2413–2446.Google Scholar
  3. 3.
    Vasan RS, Beiser A, Seshadri S, et al.: Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. JAMA 2002, 287:1003–1010.PubMedCrossRefGoogle Scholar
  4. 4.
    Greenlund KJ, Croft JB, Mensah GA: Prevalence of heart disease and stroke risk factors in persons with prehypertension in the United States, 1999–2000. Arch Intern Med 2004, 164:2113–2118.PubMedCrossRefGoogle Scholar
  5. 5.
    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
  6. 6.
    Winegarden CR: From “prehypertension” to hypertension? Additional evidence. Ann Epidemio 2005, 15:720–725.CrossRefGoogle Scholar
  7. 7.
    Julius S, Nesbitt SD, Egan BM, et al.: Feasibility of treating prehypertension with an angiotensin-receptor blocker. N Engl J Med 2006, 354:1685–1697.PubMedCrossRefGoogle Scholar
  8. 8.
    Kannel WB, Brand N, Skinner JJ Jr, et al.: The relation of adiposity to blood pressure and development of hypertension. The Framingham study. Ann Intern Med 1967, 67:48–59.PubMedGoogle Scholar
  9. 9.
    Moore LL, Visioni AJ, Qureshi MM, et al.: Weight loss in overweight adults and the long-term risk of hypertension: the Framingham study. Arch Intern Med 2005, 165:1298–1303.PubMedCrossRefGoogle Scholar
  10. 10.
    Halperin RO, Sesso HD, Ma J, et al.: Dyslipidemia and the risk of incident hypertension in men. Hypertension 2006, 47:45–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Haffner SM, Miettinen H, Gaskill SP, Stern MP: Metabolic precursors of hypertension. The San Antonio Heart Study. Arch Intern Med 1996, 156:1994–2001.PubMedCrossRefGoogle Scholar
  12. 12.
    Glorioso N, Troffa C, Filigheddu F, et al.: Effect of the HMG-CoA reductase inhibitors on blood pressure in patients with essential hypertension and primary hypercholesterolemia. Hypertension 1999, 34:1281–1286.PubMedGoogle Scholar
  13. 13.
    Ferrier KE, Muhlmann MH, Baguet JP, et al.: Intensive cholesterol reduction lowers blood pressure and large artery stiffness in isolated systolic hypertension. J Am Coll Cardiol 2002, 39:1020–1025.PubMedCrossRefGoogle Scholar
  14. 14.
    Port S, Demer L, Jennrich R, et al.: Systolic blood pressure and mortality. Lancet 2000, 355:175–180.PubMedCrossRefGoogle Scholar
  15. 15.
    Lewington S, Clarke R, Qizilbash N, et al.: Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002, 360:1903–1913.PubMedCrossRefGoogle Scholar
  16. 16.
    Kannel WB, Vasan RS, Levy D: Is the relation of systolic blood pressure to risk of cardiovascular disease continuous and graded, or are there critical values? Hypertension 2003, 42:453–456.PubMedCrossRefGoogle Scholar
  17. 17.
    van den Hoogen PC, Feskens EJ, Nagelkerke NJ, et al.: The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. Seven Countries Study Research Group. N Engl J Med 2000, 342:1–8.PubMedCrossRefGoogle Scholar
  18. 18.
    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, 345:1291–1297.PubMedCrossRefGoogle Scholar
  19. 19.
    Liszka HA, Mainous AG 3rd, King DE, et al.: Prehypertension and cardiovascular morbidity. Ann Fam Med 2005, 3:294–299.PubMedCrossRefGoogle Scholar
  20. 20.
    Mainous AG 3rd, Everett CJ, Liszka H, et al.: Prehypertension and mortality in a nationally representative cohort. Am J Cardiol 2004, 94:1496–1500.PubMedCrossRefGoogle Scholar
  21. 21.
    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, 47:410–414.PubMedCrossRefGoogle Scholar
  22. 22.
    Kshirsagar AV, Carpenter M, Bang H, et al.: Blood pressure usually considered normal is associated with an elevated risk of cardiovascular disease. Am J Med 2006, 119:133–141.PubMedCrossRefGoogle Scholar
  23. 23.
    Yusuf S, Sleight P, Pogue J, et al.: Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000, 342:145–153.PubMedCrossRefGoogle Scholar
  24. 24.
    Fox KM: Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003, 362:782–788.PubMedCrossRefGoogle Scholar
  25. 25.
    Braunwald E, Domanski MJ, Fowler SE, et al.: Angiotensin-converting-enzyme inhibition in stable coronary artery disease. N Engl J Med 2004, 351:2058–2068.PubMedCrossRefGoogle Scholar
  26. 26.
    Poole-Wilson PA, Lubsen J, Kirwan BA, et al.: Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatment (ACTION trial): randomised controlled trial. Lancet 2004, 364:849–857.PubMedCrossRefGoogle Scholar
  27. 27.
    Lubsen J, Wagener G, Kirwan BA, de Brouwer S, Poole-Wilson PA. Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with symptomatic stable angina and hypertension: the ACTION trial. J Hypertens 2005, 23:641–648.PubMedCrossRefGoogle Scholar
  28. 28.
    Nissen SE, Tuzcu EM, Libby P, et al.: Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial. JAMA 2004, 292:2217–2225.PubMedCrossRefGoogle Scholar
  29. 29.
    PROGRESS Collaborative Group: Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001, 358:1033–1041.CrossRefGoogle Scholar
  30. 30.
    PROGRESS Collaborative Group: Effects of a perindopril-based blood pressure lowering regimen on cardiac outcomes among patients with cerebrovascular disease. Eur Heart J 2003, 24:475–484.Google Scholar
  31. 31.
    Neaton JD, Grimm RH Jr, Prineas RJ, et al.: Treatment of Mild Hypertension Study. Final results. Treatment of Mild Hypertension Study Research Group. JAMA 1993, 270:713–724.PubMedCrossRefGoogle Scholar
  32. 32.
    Julius S, Kjeldsen SE, Weber M, et al.: Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004, 363:2022–2031.PubMedCrossRefGoogle Scholar
  33. 33.
    Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002, 288:2981–2997.Google Scholar
  34. 34.
    Pepine CJ, Handberg EM, Cooper-DeHoff RM, et al.: A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA 2003, 290:2805–2816.PubMedCrossRefGoogle Scholar
  35. 35.
    Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). ALLHAT Collaborative Research Group. JAMA 2000, 283:1967–1975.Google Scholar
  36. 36.
    Messerli FH, Mancia G, Conti CR, et al.: Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med 2006, 144:884–893.PubMedGoogle Scholar
  37. 37.
    Farnett L, Mulrow CD, Linn WD, et al.: The J-curve phenomenon and the treatment of hypertension. Is there a point beyond which pressure reduction is dangerous? JAMA 1991, 265:489–495.Google Scholar
  38. 38.
    Hansson L, Zanchetti A, Carruthers SG, et al.: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998, 351:1755–1762.PubMedCrossRefGoogle Scholar
  39. 39.
    Weber T, Auer J, Eber B, O’Rourke MF: Diastolic blood pressure in coronary artery disease. Ann Intern Med 2007, 146:149.PubMedGoogle Scholar
  40. 40.
    Stamler R, Stamler J, Gosch FC, et al.: Primary prevention of hypertension by nutritional-hygienic means. Final report of a randomized, controlled trial. JAMA 1989, 262:1801–1807.PubMedCrossRefGoogle Scholar
  41. 41.
    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. The Trials of Hypertension Prevention Collaborative Research Group. Arch Intern Med 1997, 157:657–667.Google Scholar
  42. 42.
    Whelton PK, Appel LJ, Espeland MA, et al.: Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA 1998, 279:839–846.PubMedCrossRefGoogle Scholar
  43. 43.
    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, 336:1117–1124.PubMedCrossRefGoogle Scholar
  44. 44.
    Sacks FM, Svetkey LP, Vollmer WM, et al.: Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001, 344:3–10.PubMedCrossRefGoogle Scholar
  45. 45.
    Vollmer WM, Sacks FM, Ard J, et al.: Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial. Ann Intern Med 2001, 135:1019–1028.PubMedGoogle Scholar
  46. 46.
    Appel LJ, Champagne CM, Harsha DW, et al.: Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA 2003, 289:2083–2093.PubMedCrossRefGoogle Scholar
  47. 47.
    Whelton SP, Chin A, Xin X, He J: Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med 2002, 136:493–503.PubMedGoogle Scholar
  48. 48.
    Cornelissen VA, Fagard RH: Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension 2005, 46:667–675.PubMedCrossRefGoogle Scholar
  49. 49.
    Cornelissen VA, Fagard RH: Effect of resistance training on resting blood pressure: a meta-analysis of randomized controlled trials. J Hypertens 2005, 23:251–259.PubMedCrossRefGoogle Scholar
  50. 50.
    Stamler R, Stamler J, Grimm R, et al.: Nutritional therapy for high blood pressure. Final report of a four-year randomized controlled trial—the Hypertension Control Program. JAMA 1987, 257:1484–1491.PubMedCrossRefGoogle Scholar
  51. 51.
    Persell SD, Baker DW: Studying Interventions to Prevent the Progression from Prehypertension to Hypertension: Does TROPHY Win the Prize? Am J Hypertens 2006, 19:1095–1097.PubMedCrossRefGoogle Scholar
  52. 52.
    Meltzer JI: A specialist in clinical hypertension critiques the TROPHY trial. Am J Hypertens 2006, 19:1098–1100.PubMedCrossRefGoogle Scholar
  53. 53.
    European Society of Hypertension-European Society of Cardiology Guidelines Committee: 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003, 21:1011–1053.CrossRefGoogle Scholar
  54. 54.
    Bosch J, Yusuf S, Pogue J, et al.: Use of ramipril in preventing stroke: double blind randomised trial. BMJ 2002, 324:699–702.PubMedCrossRefGoogle Scholar
  55. 55.
    Svensson P, de Faire U, Sleight P, et al.: Comparative effects of ramipril on ambulatory and office blood pressures: a HOPE Substudy. Hypertension 2001, 38:E28–E32.PubMedGoogle Scholar

Copyright information

© Current Medicine Group LLC 2007

Authors and Affiliations

  1. 1.Division of General Internal Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoUSA

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