Drug Therapy for Prehypertension Questioned

Abstract

SOME RESEARCHERS ARE QUESTIONing a claim made by the authors of a recent study that it is feasible to use drug treatment to reduce the risk that patients with prehypertension will progress to hypertension. In that study, the Trial of Preventing Hypertension (TROPHY), participants were randomly assigned to receive an angiotensin II receptor blocker, candesartan (AstraZeneca LP, London, England), or placebo for 2 years. All patients were then given placebo and followed up for an additional 2 years (Julius S et al. N Engl J Med. 2006;354: 1685-1697). At the 2-year mark, there was a major reduction in the number of participants progressing to hypertension in the candesartan group compared with those in the placebo group. At 4 years, the proportion of participants moving into hypertension in the candesartan group was only slightly smaller than that of the placebo group. The authors concluded that “treatment of prehypertension appears to be feasible.” The study was funded, in part, by a grant from AstraZeneca. But now other researchers argue in a pair of editorials published in the November 23 issue of the American Journal of Hypertension that the study was flawed and the study authors’ conclusion is misleading. The emerging debate on how best to treat prehypertension has enormous public health implications. An estimated 70 million individuals in the United States have prehypertension (generally defined as having a systolic blood pressure in the range of 120139 mm Hg or a diastolic blood pressure in the range of 80-89 mm Hg), with most destined to progress to hypertension, a well-recognized risk factor for heart disease, stroke, and kidney disease. Current guidelines for treating prehypertension recommend lifestyle modifications, such as weight loss, exercise, and sodium restriction. But because adherence to lifestyle modification to prevent hypertension is generally poor, the TROPHY authors hoped that a short-term regimen using an angiotensin II receptor blocker could prevent or delay onset of high blood pressure.