The (pre)hypertension limbo

In 2003, the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) proposed the term “prehypertension” to designate systolic blood pressure (SBP) of 120 to 139 mm Hg and diastolic blood pressure (DBP) of 80–89 mm Hg.¹ This classification was based on data that demonstrated a strong, independent, continuous association between blood pressure levels and risk of stroke, ischemic heart disease, and cardiovascular mortality. Above SBP of 115 mm Hg and DBP of 75 mm Hg, this risk doubles with each increment of 20/10 mm Hg.^2,3 The term “prehypertension” has been debated contentiously. The 2007 report from the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) preferred to include the 120–129/80–84 mm Hg group with those with “normal blood pressure” and termed the 130–139/85–89 mm Hg group “high normal.”³

The prevalence of prehypertension in the United States is not trivial. About 25% of the adult population is affected (about equal in number to those diagnosed with hypertension).^4,5 Approximately 90% of these individuals have at least one other cardiovascular risk factor …