Prehypertension (blood pressure 120-139/80-89 mmHg) affects ~25-50% of adults worldwide, and increases the risk of incident
hypertension. The relative risk of incident
hypertension declines by ~20% with intensive lifestyle intervention, and by 34-66% with single
antihypertensive medications. To prevent one case of incident
hypertension in adults with
prehypertension and a 50% 5-year risk of
hypertension, 10 individuals would need to receive intensive lifestyle intervention, and four to six patients would need to be treated with
antihypertensive medication. The relative risk of incident
cardiovascular disease (CVD) is greater with 'stage 2' (130-139/85-89 mmHg) than 'stage 1' (120-129/80-84 mmHg)
prehypertension; only stage 2
prehypertension increases cardiovascular mortality. Among individuals with
prehypertension, the 10-year absolute CVD risk for middle-aged adults without
diabetes mellitus or CVD is ~10%, and ~40% for middle-aged and older individuals with either or both comorbidities.
Antihypertensive medications reduce the relative risk of CVD and death by ~15% in
secondary-prevention studies of
prehypertension. Data on primary prevention of CVD with
pharmacotherapy in
prehypertension are lacking. Risk-stratified, patient-centred, comparative-effectiveness research is needed in
prehypertension to inform an acceptable, safe, and effective balance of lifestyle and medication interventions to prevent incident
hypertension and CVD.