Published online before print May 16, 2005, doi: 10.1161/01.HYP.0000167152.98618.4b
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(Hypertension. 2005;45:1056.)
© 2005 American Heart Association, Inc.
Hypertension Grand Rounds |
Management of Prehypertension
From the Duke Hypertension Center and the Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC.
Correspondence to Laura P. Svetkey, MD, Box 3075 Duke University Medical Center, Durham, NC 27710. E-mail svetk001@mc.duke.edu
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Introduction |
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A 58-year-old woman is evaluated by her primary care physician, her gynecologist, or at employee health. On 2 separate occasions, duplicate seated blood pressure (BP) measurements average 132/84 mm Hg. She is informed that she has "prehypertension." At her last check-up in 2002, she had a similar reading but was told she had normal BP.
The BP category "prehypertension" was first introduced by the Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) in 2003, replacing former categories of "high-normal" and "above-optimal" BP.1 The rationale for redefining this category was to emphasize the excess risk associated with BP in this range and to focus increased clinical and public health attention on prevention.
Management of prehypertension by lowering BP into a more optimal range can be expected to lower risk. The risks associated with prehypertension are in part related to the tendency of BP to increase with age in industrialized societies. Thus, prehypertension is a precursor of clinical hypertension and consequently of the cardiovascular disease (CVD) and renal risks associated with elevated BP (ie, SBP 
140 or DBP 90 mm Hg). In addition, the relationship between BP and CVD risk is continuous over the whole range of BP, and therefore, prehypertension itself is associated with BP-related morbidity and mortality. Thus, the goals of treating prehypertension are to prevent hypertension and to reduce the excess CVD risk associated with BP in this preclinical range.
Although treatment of prehypertension is primarily nonpharmacological lifestyle change, redefining this range
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