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Pre-Hypertension: Rationale for Pharmacotherapy

Current Hypertension Reports volume 15, pages 669–675 (2013)Cite this article

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.

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Conflict of Interest

Brent M. Egan and Marilyn A. Laken declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Affiliations

  1. School of Medicine Greenville, Greenville Health System, Care Coordination Institute, University of South Carolina, Greenville, SC, USA

    Brent M. Egan

  2. Medical University of South Carolina, Charleston, SC, USA

    Brent M. Egan & Marilyn A. Laken

  3. Care Coordination Institute, University of South Carolina School of Medicine – Greenville, P. O. Box 367, Greenville, SC, 29602, USA

    Brent M. Egan

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  1. Brent M. Egan
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  2. Marilyn A. Laken
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Correspondence to Brent M. Egan.

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Egan, B.M., Laken, M.A. Pre-Hypertension: Rationale for Pharmacotherapy. Curr Hypertens Rep 15, 669–675 (2013). https://doi.org/10.1007/s11906-013-0387-7

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Keywords

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