Do You Have Prehypertension?
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Do You Have Prehypertension?

Image for hypertension articleIn 2003, new blood pressure guidelines gave us a wake up call. The National High Blood Pressure Education Program released stricter rules. Their goal was to increase public awareness of hypertension prevention and treatment. A new blood pressure section called prehypertension was added. Blood pressure levels that had been called normal now became prehypertensive.

New Blood Pressure Standards

Hypertension, or high blood pressure, is diagnosed when a blood pressure reading of 140/90 mmHg or greater is noted. The level must be seen on at least two readings to be officially diagnosed. The upper number is the systolic pressure when your heart contracts. The lower number is the diastolic pressure when your heart relaxes.

If your blood pressure was 139/89 mmHg or below, it was considered normal. With 2003 guidelines, only a reading below 120/80 mmHg is considered normal. When your blood pressure is slightly higher than this, you have prehypertension.

Here is a summary of the new classification system. Recommended therapy is listed for each level of blood pressure.

Categories for Blood Pressure Levels in Adults

CategorySystolic blood pressure (mm Hg)Diastolic blood pressure (mm Hg)Lifestyle changes advisedDrugs usually recommended
NormalLess than 120Less than 80EncouragedNo
Prehypertension120-13980-89YesNo
Stage 1 hypertension140-15990-99YesYes
Stage 2 hypertension160 or more100 or moreYesYes
Modified from Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. JAMA. 2003;289:2560-2572.

Prehypertension Risk

Prehypertensive patients are more likely to develop full-blown hypertension. They are also more likely to develop associated health problems. Heart disease, stroke, kidney disease, blindness, and Alzheimer’s disease are all associated with hypertension.

Studies indicate cardiovascular risk increases as blood pressure rises above 115/75 mmHg. In fact, your risk doubles with every 20 mmHg rise in systolic pressure or with every 10 mmHg rise in diastolic pressure.

Who Should Get Screened?

According to the National High Blood Pressure Education Program, everyone should have a blood pressure check at least once every two years. If your blood pressure is above normal (that is, higher than 120/80 mmHg), your doctor may recommend that you have it rechecked more often. People at increased risk for hypertension may also need more frequent readings. Risk factors include a family history of the condition, African American race, above-normal weight, or age greater than 50.

Prehypertension Treatment

Unlike hypertension, prehypertension treatment does not usually include drugs. The mainstay of therapy for prehypertension is lifestyle changes. These changes can help to slow or prevent progression to hypertension. The National High Blood Pressure Education Program recommends:

  • Lose excess weight. Studies show that each 10 pounds of weight loss is associated with an average drop in systolic blood pressure of up to about 10 millimeters of mercury.
  • Increase physical activity to at least 30 minutes most days of the week. First get your doctor’s approval if you’re not accustomed to exercise.
  • Eat a healthful diet. Daily food intake should be low in saturated fat and cholesterol and rich in whole grains, fruit and vegetables, and lowfat dairy foods.
  • Reduce salt intake to no more than 2.4 grams (g) of sodium (the equivalent of about a teaspoon of table salt) a day.
  • Limit alcohol use. This meaning no more than two drinks a day for men or one for women.

Abysmal Blood Pressure Control

“The majority of cases of hypertension can be prevented and controlled,” writes Thomas Kottke, MD, of the Mayo Clinic in an editorial that accompanies the guidelines. But he notes that Americans, are failing to make the grade. Despite scientific advances, government surveys show that public awareness of high blood pressure has not improved over the past 10 years. Only about one-third of patients with hypertension receive adequate treatment today.

Prevention Needed

In hopes of improving the situation, the National High Blood Pressure Education Program released the new guidelines to emphasize the need for more aggressive prevention, detection, and treatment. Presently, over 50 million people in this country have high blood pressure and an estimated 45 million more have prehypertension. If we don’t take action now, 90% of us will likely develop high blood pressure during our lives. In order to stave off a looming epidemic of hypertension, prevention is urgently needed.

RESOURCES:

American Heart Association
http://www.americanheart.org

Mayo Clinic
http://www.mayoclinic.com

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/hbp

CANADIAN RESOURCES:

Canadian Cardiovascular Society
http://www.ccs.ca/home/index_e.aspx

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/Page.asp?PageID=24

References

Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. JAMA. 2003;289:2560-2572.

Kottke TE, Stroebel RJ, Hoffman RS. JNC 7—It’s more than high blood pressure. Editorial. JAMA. 2003;289:2573-2575.

Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903-1913.

The Sixth Report on the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National High Blood Pressure Education Program, National Institutes of Health; 1997. Publication No. 98-4080.

Vasan RS, Beiser A, Seshadri, S, et al. Residual lifetime risk for developing hypertension in middle-aged women and men. JAMA. 2002;287:1003-1010.

Who can develop high blood pressure? National Heart, Lung, and Blood Institute (NHLBI). National Institutes of Health (NIH). Available at: http://www.nhlbi.nih.gov/hbp/hbp/develop.htm. Accessed June 12, 2003.

Why is high blood pressure important? National Heart, Lung, and Blood Institute (NHLBI). National Institutes of Health (NIH). Available at: http://www.nhlbi.nih.gov/hbp/hbp/serious.htm. Accessed June 12, 2003.



Last reviewed March 2008 by Michael J. Fucci, DO

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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