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Prehypertension: Risk stratification and management considerations

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Abstract

Approximately 37% of US adults are prehypertensive; about 31 million have blood pressures in the range of 130–139/85–89 mm Hg. These stage 2 prehypertensives have threefold greater risk for developing hypertension and twofold higher risk for cardiovascular events than normotensives. Lifestyle changes only are recommended for most prehypertensives, but evidence for community-wide effectiveness is limited. Projected numbers needed to treat to prevent a cardiovascular event are similar for stage 2 prehypertension and stage 1 hypertension when both groups are matched for concomitant risk factors. However, no clinical trials document that pharmacotherapy reduces cardiovascular events in stage 2 prehypertension. The Trial of Preventing Hypertension demonstrated that angiotensin receptor blockade safely lowers blood pressure and prevents or delays progression to hypertension in stage 2 prehypertensives. We believe it is reasonable for clinicians to identify stage 2 prehypertensives at high absolute risk for progression to hypertension and cardiovascular events, and to treat them with a renin-angiotensin system blocker when life-style changes alone are ineffective.

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  1. Medical University of South Carolina, 135 Rutledge Avenue, RT1104, Charleston, SC, 29425, USA

    Brent M. Egan

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  2. Stevo Julius
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Correspondence to Brent M. Egan.

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Egan, B.M., Julius, S. Prehypertension: Risk stratification and management considerations. Current Science Inc 10, 359–366 (2008). https://doi.org/10.1007/s11906-008-0068-0

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