Should Prehypertension Be Treated?

The blood pressure category termed prehypertension was created for pressures between 120 and 139 mm Hg systolic (the upper number) and 80 to 89 mm Hg diastolic (the lower number). Values in this range (either the systolic or the diastolic) have been shown to be linked to an increased risk of heart attack and stroke, so it would seem to make sense that they should be treated.  But until now, the benefit of treating this level of raised blood pressure has not been clear.  A meta-analysis of 16 individual studies, which has just been published online in Stroke: the Journal of the American Heart Association, resolves this problem. 

There were more than 70,000 prehypertension subjects in the analysis.  Those that were treated with one or more of 95 antihypertensive drugs had a statistically significant reduction in their risk of having a stroke; this amounted to a 22% reduction compared with placebo.  Put another way, to prevent one stroke, 169 patients had to be treated with an antihypertensive drug for an average of 4.3 years. 

Prehypertension is very common, and may affect more than 50 million adults in the United States.  Not everyone with prehypertension will go on to develop hypertension, but many will. Lifestyle changes are clearly recommended for such patients – quitting smoking, losing weight, and getting regular physical exercise.  These can be effective, if implemented consistently.  But otherwise, prehypertensive patients should be treated with appropriate medications, according to the results of this meta-analysis. The possible effectiveness of these drugs can be seen in regular blood pressure measurements.  It’s an approach that is well worth while, in my opinion.