Prehypertension, whether to treat?

Prehypertension, whether to treat?

Prehypertension (pre-HT) was a term coined by JNC 7. It is the result of  ‘lifestyle syndrome’ – consuming too much calories and having too little physical activity. Association of diabetes increase the risk associated with pre-HT. Persons with pre-HT have higher levels of resistin and lower levels of adiponectin. Vascular damage starts in the prehypertensive phase. Role of of lifestyle modification inpre-HT is well known. Earlier clinical outcome trials have not demonstrated benefits of drug therapy in prehypertension. TROPHY trial was one of the first trials of drug therapy of prehypertension. The active treatment arm was on candesartan. The end point was development of hypertension. There was a reduction in development of new hypertension in the active treatment arm. One of the criticisms on the trial was that a good number had features of metabolic syndrome which placed them in high risk group. IVUS substudy of CAMELOT showed better reduction of coronary atheroma progression in pre hypertensives. As of now, benefit of treating isolated prehypertension has not been substantiated, but in those with associated risk factors like diabetes has to be considered. The emphasis to be first on lifestyle modifications in prehypertension.

The term prehypertension has been dropped in the 2017 ACC/AHA guidelines [1] in which elevated blood pressure is between 120-129 mmHg systolic and diastolic below 80 mm Hg. Systolic blood pressure 130-139 mmHg or diastolic between 80-89 mmHg is Stage 1 hypertension. Systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg is termed Stage 2 hypertension.

Reference

1. Paul K Whelton, Robert M Carey, Wilbert S Aronow, Donald E Casey Jr, Karen J Collins, Cheryl Dennison Himmelfarb, Sondra M DePalma, Samuel Gidding, Kenneth A Jamerson, Daniel W Jones, Eric J MacLaughlin, Paul Muntner, Bruce Ovbiagele, Sidney C Smith Jr, Crystal C Spencer, Randall S Stafford, Sandra J Taler, Randal J Thomas, Kim A Williams Sr, Jeff D Williamson, Jackson T Wright Jr. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):2199-2269.