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Prehypertension: epidemiology, consequences and treatment

Nature Reviews Nephrology volume 6, pages 21–30 (2010)Cite this article

Abstract

The term prehypertension was coined in 1939 in the context of early studies that linked high blood pressure recorded during physical examination for life insurance purposes to subsequent morbidity and mortality. These studies demonstrated that individuals with blood pressure >120/80 mmHg, but <140/90 mmHg—the accepted value for the lower limit of the hypertensive range—had an increased risk of hypertension, cardiovascular disease and early death from cardiovascular causes. The prehypertension classification of blood pressure was later used by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure to define a group of individuals at increased risk of cardiovascular events because of elevated blood pressure, an increased burden of other risk factors such as obesity, diabetes mellitus, dyslipidemia, and inflammatory markers, and evidence of organ damage for example, microalbuminuria, retinal arteriolar narrowing, increased carotid arterial intima-media thickness, left ventricular hypertrophy and coronary artery disease. Nonpharmacological treatment with lifestyle modifications such as weight loss, dietary modification and increased physical activity is recommended for all patients with prehypertension as these approaches effectively reduce risk of cardiovascular events. Pharmacological therapy is indicated for some patients with prehypertension who have specific comorbidities, including diabetes mellitus, chronic kidney disease and coronary artery disease.

Key Points

  • Prehypertension is highly prevalent and is associated with the traditional cardiovascular risk factors linked to hypertension, such as obesity, diabetes mellitus and dyslipidemia

  • Patients with prehypertension (120–139/80–89 mmHg) have an increased risk of cardiovascular morbidity and mortality compared with patients who have normal blood pressure (<120/80 mmHg)

  • Lifestyle modifications are recommended for all patients with prehypertension and effectively reduce cardiovascular risk

  • Outcome studies are needed to establish the value of pharmacologic therapy for the treatment of prehypertension

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Figure 1: Mortality from ischemic heart disease and stroke increases with increasing blood pressure.
Figure 2: Effect of high-normal blood pressure on risk of cardiovascular disease.
Figure 3: Incidence of cardiovascular disease (CVD) following dietary sodium reduction.
Figure 4: Effect of dietary sodium reduction on mortality.
Figure 5: Risk of developing hypertension is reduced by treatment with candesartan cilexetil.

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Endocrine Hypertension Research Center and Clinical Center of Research Excellence in Cardiovascular Disease and Metabolic Disorders, Hypertension Unit, University of Queensland School of Medicine, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD 4102, Brisbane, Australia

    Eduardo Pimenta

  2. Vascular Biology and Hypertension Program of the Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 1034 Zeigler Research Building, University Station, Birmingham, 35294, AL, USA

    Suzanne Oparil

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Correspondence to Eduardo Pimenta.

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Pimenta, E., Oparil, S. Prehypertension: epidemiology, consequences and treatment. Nat Rev Nephrol 6, 21–30 (2010). https://doi.org/10.1038/nrneph.2009.191

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