Management of prehypertension.

A58-year-old woman is evaluated by her primary care physician, her gynecologist, or at employee health. On 2 separate occasions, duplicate seated blood pressure (BP) measurements average 132/84 mm Hg. She is informed that she has “prehypertension.” At her last check-up in 2002, she had a similar reading but was told she had normal BP. The BP category “prehypertension” was first introduced by the Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) in 2003, replacing former categories of “highnormal” and “above-optimal” BP.1 The rationale for redefining this category was to emphasize the excess risk associated with BP in this range and to focus increased clinical and public health attention on prevention. Management of prehypertension by lowering BP into a more optimal range can be expected to lower risk. The risks associated with prehypertension are in part related to the tendency of BP to increase with age in industrialized societies. Thus, prehypertension is a precursor of clinical hypertension and consequently of the cardiovascular disease (CVD) and renal risks associated with elevated BP (ie, SBP 140 or DBP 90 mm Hg). In addition, the relationship between BP and CVD risk is continuous over the whole range of BP, and therefore, prehypertension itself is associated with BP-related morbidity and mortality. Thus, the goals of treating prehypertension are to prevent hypertension and to reduce the excess CVD risk associated with BP in this preclinical range. Although treatment of prehypertension is primarily nonpharmacological lifestyle change, redefining this range of BP also serves to emphasize the role of health care providers in its management. The terms “high-normal” or “aboveoptimal” BP in previous JNC reports might have implied in the past that appropriate action should originate in the public health or the lay public sectors, but the label “prehypertension” clearly calls for the attention of the physician. The management of prehypertension is an appropriate goal for clinicians in a wide range of practice settings. This review will discuss the epidemiology and risk of prehypertension, the evidence underlying treatment recommendations, clinical and public health implications of prehypertension and its management, and issues concerning implementation of treatment recommendations.