Prehypertension

Doctor taking woman's blood pressure
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If you have been told you have prehypertension, it means that your blood pressure measurement is higher than the "normal" range, but is not high enough to warrant a formal diagnosis of hypertension. As the name implies, patients with prehypertension have a particularly high risk of developing actual hypertension in the relatively near future.

What Is Prehypertension?

When your doctor measures your blood pressure, he or she classifies the results as follows:

What Is the Significance of Prehypertension?

While a blood pressure of 140/90 or higher is considered to be "hypertension," this cutoff is actually a fairly arbitrary one.

Once your blood pressure is higher than the "normal" range (120/80 mmHg), your cardiovascular risk begins to rise, and the higher your blood pressure, the higher your risk. In fact, the main distinction between "hypertension" and "prehypertension" merely is that for the former, many randomized clinical trials have been done to demonstrate that aggressive treatment can improve outcomes.

Those kinds of trials are in a relatively early stage for prehypertension, so, to this point, aggressive treatment with antihypertensive drugs has not been proven to yield better outcomes in prehypertension (with the exceptions noted below).

So "prehypertension" is more than just a blood pressure that is a little higher than normal, or that is likely to rise to the levels of "real" hypertension as time goes by.

Prehypertension itself increases your risk to at least some degree.

How Is Prehypertension Treated?

If you are otherwise healthy, current recommendations are to treat prehypertension with lifestyle changes: diet, exercise, smoking cessation, and avoiding excess alcohol.

However, if you have prehypertension and also have coronary artery disease, peripheral artery disease, diabetes or chronic kidney disease, there is enough clinical evidence to show that more aggressive treatment improves outcomes -- so drug therapy is usually recommended, with the goal of reducing your blood pressure down to the normal range.

If you have prehypertension your risk of developing actual hypertension is very high. So you should make sure you have your blood pressure rechecked at least every six to 12 months. Odds are good that at some point you will need to be on therapy for high blood pressure.

Sources:

Chobanian, AV, Bakris, GL, Black, HR, Cushman, WC. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 2003; 289:2560.

Vasan, RS, Larson, MG, Leip, EP, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001; 345:1291.

Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management of hypertension in the community a statement by the American Society of Hypertension and the International Society of Hypertension. J Hypertens 2014; 32:3.

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