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Prehypertension

Nature Clinical Practice Cardiovascular Medicine volume 4, pages 538–548 (2007)Cite this article

Abstract

Prehypertension—blood pressure between 120–139/80–89 mmHg—is a major public health concern. The condition is very prevalent (especially in obese young people), is often associated with other cardiovascular risk factors and independently increases the risk of hypertension and subsequent cardiovascular events. In the general population, prehypertension can be lowered, but not often reliably, by lifestyle modifications. Drug therapy for prehypertension is not yet recommended, except for individuals with diabetes, chronic kidney disease, and perhaps known coronary artery disease, because of short-term cost considerations and unproven long-term benefits. Ongoing research will probably identify which individuals with blood pressures in the prehypertensive range, but with no serious comorbidities, would benefit from treatment. In this Review, we attempt to summarize the recently published data concerning the epidemiology, attendant risks and potential treatment options for this important and growing public-health problem.

Key Points

  • Prehypertension is the term used by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure to define persistent office blood pressures between 120–139/80–89 mmHg, inclusive

  • In comparison with people who have normal blood pressures (<120/80 mmHg), individuals with blood pressure in the prehypertensive range are more likely to have other cardiovascular risk factors, develop sustained hypertension, require pharmacological therapy to reduce their blood pressure, and have raised cardiovascular event risk

  • Lifestyle modifications, including weight loss, sodium restriction and other dietary measures should be recommended to, and adopted by, all individuals with prehypertension or hypertension

  • Although the feasibility of drug therapy for prehypertension has been shown, the risk:benefit ratio is uncertain, and the cost would be high

  • Future studies (including PILL and AVIATOR studies) might help clarify the potential role of drug therapy for prehypertension

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Figure 1: Kaplan–Meier incidence curves for the transition from prehypertension to hypertension in the Trial of Preventing Hypertension (TROPHY).

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Authors and Affiliations

  1. and Pharmacology at the Department of Preventive Medicine, WJ Elliott is Professor of Preventive Medicine, Internal Medicine, RUSH Medical College of RUSH University at RUSH University Medical Center, Chicago, IL,

    William J Elliott

  2. HR Black is Clinical Professor of Internal Medicine at New York University School of Medicine, New York, NY, USA.,

    Henry R Black

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Correspondence to William J Elliott.

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Competing interests

WJ Elliott has received research grants from Pfizer. He has been on the speakers' bureau or received honoraria from Abbott Laboratories, AstraZeneca, Biovail Pharmaceuticals, Bristol-Myers Squibb, Novartis Pharmaceuticals, Pfizer, Sanofi-Aventis and Sanofi-Synthelabo. He has been a consultant/advisory board member for Biovail Pharmaceuticals, Bristol-Myers Squibb/Sanofi-Aventis and Bristol-Myers Squibb/Sanofi-Synthelabo, Novartis Pharmaceuticals and Pfizer.

HR Black has been on the speakers' bureau or received honoraria from Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Forest Laboratories, Novartis Pharmaceuticals, Pfizer, Sanofi-Aventis and Sanofi-Synthelabo. He has been a consultant/advisory board member for Bristol-Myers Squibb/Sanofi-Aventis and Bristol-Myers Squibb/Sanofi-Synthelabo, Daiichi-Sankyo, Forest Laboratories, Gilead, Itercure, Merck, Myogen, Novartis Pharmaceuticals, Pfizer and Sanofi-Aventis.

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Elliott, W., Black, H. Prehypertension. Nat Rev Cardiol 4, 538–548 (2007). https://doi.org/10.1038/ncpcardio0989

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