Experts Ponder Treating Prehypertension

Abstract

PATIENTS WITH BLOOD PRESSURE IN the high normal range but below the hypertension threshold are at increased risk for cardiovascular disease. So how should physicians treat them? Current guidelines say that patients with “prehypertension” (systolic blood pressure of 120-139 mm Hg and/or diastolic blood pressure of 80-89 mm Hg) are not candidates for drug therapy but should be “firmly and unambiguously advised to practice lifestyle modification in order to reduce their risk of developing hypertension in the future” (http://www.nhlbi.nih.gov/guidelines /hypertension/jnc7full.pdf). Now, however, some ambiguity has been introduced. Researchers presenting findings at the American College of Cardiology’s annual Scientific Session in Atlanta in March suggested that treatment of prehypertension with candesartan, an angiotensin-receptor blocker, reduced the risk of progression to hypertension in some patients (Julius S et al. N Engl J Med. 2006;354:1685-1697). Because the current guidelines’ recommendation for lifestyle modification has not worked effectively over the broad population of patients with prehypertension, the investigators from the Trial of Preventing Hypertension (TROPHY) conducted a feasibility study to explore whether a medical treatment could reduce the risk of progression to hypertension, said Shawna D. Nesbitt, MD, one of the article’s authors. “We are trying to change the treatment of hypertension, which for years has focused on treatment at the end of progression, when organ damage is a real concern,” said Nesbitt, assistant professor of internal medicine at the University of Texas Southwestern Medical Center at Dallas. “The question was whether we could intervene earlier, before people reach this point.” Although guidelines suggested lifestyle management of prehypertension has resulted in some reduction in blood pressure, such results are short-lived and