Julius S et al. (2006) Feasibility of treating prehypertension with an angiotensin-receptor blocker. N Engl J Med 354: 1685–1697

Many people with prehypertension go on to develop hypertension. Prehypertension is associated with excess morbidity and deaths, as well as other cardiovascular risk factors. The Trial of Preventing Hypertension (TROPHY) attempted to determine whether the development of hypertension could be prevented or delayed by the treatment of prehypertension.

Participants classified as having prehypertension (130–139/≤89 mmHg or ≤139/85–89 mmHg) were randomly assigned to receive either 16 mg of the angiotensin-receptor blocker candesartan or placebo daily for 2 years. At the end of this period, hypertension had developed in 53 of 391 (13.6%) patients in the candesartan group and in 154 of 381 (40.4%) patients in the placebo group (P <0.001), equating to a relative risk of 0.34 (95% CI 0.25–0.44) for the candesartan group. After 2 further years in which both groups received placebo, incidence of hypertension remained lower in the candesartan group: hypertension developed in 208 (53.2%) patients in this group compared with 240 (63.0%) patients in the placebo group, indicating a relative risk of 0.84 (95% CI 0.75–0.95) for the candesartan-treated patients.

Previous studies have shown that individuals with prehypertension are at increased risk of coronary disease and stroke; the findings in this study suggest that pharmacotherapy for the control of prehypertension is an effective and well-tolerated way to reduce this risk. The authors state that lifestyle modification measures for the control of blood pressure have had limited effect, and suggest a cost-effectiveness comparison of pharmacotherapy versus lifestyle modification for blood pressure control.