Pre-hypertension, defined as blood pressure 120-139/80-89 mmHg, affects ~70 million people in the US. Blood pressures in the upper half of the pre-hypertensive range are linked with roughly threefold greater risk of incident
hypertension than normal blood pressure <120/<80 mmHg, with an incidence rate of 8-20 % annually. Blood pressures in the upper half of the pre-hypertensive range also roughly double risk for cardiovascular events, even in the absence of progression to
hypertension. Despite excess risk, guidelines recommend lifestyle interventions only for people with
pre-hypertension in the absence of
diabetes mellitus or clinical cardiovascular or
chronic kidney disease. While efficacious, lifestyle changes have limited population effectiveness as Americans are heavier and their nutritional patterns less DASH-like than before DASH was published. Prevalent
hypertension is higher in African Americans than Caucasians, but prevalent
pre-hypertension is similar. African Americans experience a more rapid transition from
pre-hypertension to
hypertension than Caucasians with
pre-hypertension. Interventions that normalize racial differences in incident
hypertension could, over time, improve racial equity in prevalent
hypertension and related clinical complications. Individuals with
pre-hypertension can be safely treated with
antihypertensive medications to significantly reduce incident
hypertension. Given the evidence, practical clinical trials in African Americans with
pre-hypertension to reduce and eliminate racial disparities in incident
hypertension have merit. The results of these trials could provide the foundation for clinical guidelines to reduce racial disparities in prevalent
hypertension and associated clinical cardiovascular and renal diseases.