Prehypertension Risk stratification and managemen

Authors: Brent M Egan Stevo Julius

Publish Date: 2008/10/16

Volume: 10, Issue: 5, Pages: 359-366

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Abstract

Approximately 37 of US adults are prehypertensive about 31 million have blood pressures in the range of 130–139/85–89 mm Hg These stage 2 prehypertensives have threefold greater risk for developing hypertension and twofold higher risk for cardiovascular events than normotensives Lifestyle changes only are recommended for most prehypertensives but evidence for communitywide effectiveness is limited Projected numbers needed to treat to prevent a cardiovascular event are similar for stage 2 prehypertension and stage 1 hypertension when both groups are matched for concomitant risk factors However no clinical trials document that pharmacotherapy reduces cardiovascular events in stage 2 prehypertension The Trial of Preventing Hypertension demonstrated that angiotensin receptor blockade safely lowers blood pressure and prevents or delays progression to hypertension in stage 2 prehypertensives We believe it is reasonable for clinicians to identify stage 2 prehypertensives at high absolute risk for progression to hypertension and cardiovascular events and to treat them with a reninangiotensin system blocker when lifestyle changes alone are ineffective

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