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Subclinical Vascular Damage in Prehypertension

  • Enrico Agabiti-Rosei
  • Anna Paini
  • Massimo Salvetti
Chapter
Part of the Updates in Hypertension and Cardiovascular Protection book series (UHCP)

Abstract

The relationship between blood pressure (BP) and cardiovascular events is continuous and therefore the distinction between normotension and hypertension is arbitrary. Despite this, for practical reasons, this distinction is commonly accepted, although a number of studies have shown that cardiovascular risk is increased when BP values are in the upper range of normotension. For this reason US Guidelines have proposed a distinction between normal BP and “prehypertension”, the condition in which SBP is between 120 and 139 mmHg and/or diastolic BP is between 80 and 89 mmHg. European Hypertension Guidelines define “high-normal BP”, as a SBP between 130 and 139 and/or a DBP between 85 and 89 mmHg. Despite the differences in cut-off values, studies have shown that these two conditions are associated with a greater prevalence of organ damage, a higher risk of developing hypertension and an increased risk of cardiovascular events.

In a general population in Northern Italy we have evaluated the progression to hypertension and the development of target organ damage in 420 subjects who were divided, according to BP values at the baseline visit, into three groups: normotensives (NT) (SBP/DBP <130/85 mmHg); high-normal (HN) (SBP/DBP >130/85 and <140/90 mmHg) and hypertensives (HT) (SBP/DBP ≥140/90 mmHg). At baseline and at a follow-up (FU) visit (performed after 9 years) all subjects underwent clinical examination, laboratory tests and ultrasound assessment of cardiac and vascular damage. Among patients classified as HN at baseline (30% of total), 71% developed hypertension at FU, 18% had HN BP, 11% were NT. Among subjects classified as NT at baseline, 34% developed hypertension at FU, 23% were classified as HN and 43% were NT. At follow-up in HN and in HT, as compared with NT, a significant increase of carotid IMT and LVM was observed. In conclusion, high-normal BP is a common condition in the general population; patients with BP values in the HN range not only frequently develop hypertension in the subsequent years, but also show a greater progression of preclinical organ damage.

Keywords

Prehypertension High-normal blood pressure High blood pressure Preclinical organ damage Vascular damage Left ventricular hypertrophy 

References

  1. 1.
    Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies Collaboration. 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;360:1903–13.CrossRefGoogle Scholar
  2. 2.
    Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281–357.CrossRefPubMedGoogle Scholar
  3. 3.
    Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ, National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, National High Blood Pressure Education Program Coordinating Committee. 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(19):2560–72.CrossRefPubMedGoogle Scholar
  4. 4.
    Vasan RS, Larson MG, Leip EP, Evans JC, O’Donnell CJ, Kannel WB, Levy D. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med. 2001;345(18):1291–7.CrossRefGoogle Scholar
  5. 5.
    Kokubo Y, Kamide K, Okamura T, Watanabe M, Higashiyama A, Kawanishi K, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease in a Japanese urban cohort: the Suita Study. Hypertension. 2008;52:652–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Muiesan ML, Salvetti M, Rizzoni D, Castellano M, Donato F, Agabiti-Rosei E. Association of change in left ventricular mass with prognosis during long-term antihypertensive treatment. J Hypertens. 1995;13:1091–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Devereux RB, Wachtell K, Gerdts E, Boman K, Nieminen MS, Papademetriou V, Rokkedal J, Harris K, Aurup P, Dahlöf B. Prognostic significance of left ventricular mass change during treatment of hypertension. JAMA. 2004;292:2350–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Muiesan ML, Salvetti M, Monteduro C, Bonzi B, Paini A, Viola S, Poisa P, Rizzoni D, Castellano M, Agabiti-Rosei E. Left ventricular concentric geometry during treatment adversely affects cardiovascular prognosis in hypertensive patients. Hypertension. 2004;43:731–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Enrico Agabiti-Rosei
    • 1
  • Anna Paini
    • 1
  • Massimo Salvetti
    • 1
  1. 1.Department of Medical and Surgical SciencesUniversity of BresciaBresciaItaly

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