Prehypertension and risk of cardiovascular disease

Epidemiologic data have established a continuous relationship between vascular risk and blood pressure that extends down to levels as low as 115/75 mmHg, emphasizing the lack of a critical threshold value that defines 'high' blood pressure. Acknowledging the graded and continuous nature of the relations of blood pressure to vascular risk, the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VII) introduced the new category 'prehypertension' to describe people with a systolic blood pressure between 120 and 139 mmHg and/or a diastolic blood pressure between 80 and 89 mmHg. It is estimated that 31% of the US population (70 million) has prehypertension. The risk of cardiovascular disease within this large prehypertensive population is not uniform, however, and increases with a rising concomitant burden of other vascular risk factors. Accordingly, a strategy of estimating global cardiovascular risk (by applying standardized risk prediction algorithms) and adjusting the intensity of blood pressure lowering (and reduction of other risk factors) to the absolute risk of cardiovascular disease is desirable in prehypertensive individuals. Adopting a healthier lifestyle, as recommended by JNC VII, is a critical component of the therapeutic approach to prehypertension.