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Prehypertension: risk stratification and management considerations.

Abstract
Approximately 37% of US adults are prehypertensive; about 31 million have blood pressures in the range of 130-139/85-89 mm Hg. These stage 2 prehypertensives have threefold greater risk for developing hypertension and twofold higher risk for cardiovascular events than normotensives. Lifestyle changes only are recommended for most prehypertensives, but evidence for community-wide effectiveness is limited. Projected numbers needed to treat to prevent a cardiovascular event are similar for stage 2 prehypertension and stage 1 hypertension when both groups are matched for concomitant risk factors. However, no clinical trials document that pharmacotherapy reduces cardiovascular events in stage 2 prehypertension. The Trial of Preventing Hypertension demonstrated that angiotensin receptor blockade safely lowers blood pressure and prevents or delays progression to hypertension in stage 2 prehypertensives. We believe it is reasonable for clinicians to identify stage 2 prehypertensives at high absolute risk for progression to hypertension and cardiovascular events, and to treat them with a renin-angiotensin system blocker when lifestyle changes alone are ineffective.
AuthorsBrent M Egan, Stevo Julius
JournalCurrent hypertension reports (Curr Hypertens Rep) Vol. 10 Issue 5 Pg. 359-66 (Oct 2008) ISSN: 1534-3111 [Electronic] United States
PMID18775112 (Publication Type: Journal Article, Review)
Chemical References
  • Antihypertensive Agents
Topics
  • Antihypertensive Agents (therapeutic use)
  • Disease Progression
  • Feeding Behavior
  • Humans
  • Hypertension (diagnosis, drug therapy, epidemiology, etiology, physiopathology)
  • Life Style
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • United States (epidemiology)

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