What is pre-hypertension? WSJ Blog

While a third of Americans suffer from full-blown high blood pressure, at least that many — and possibly up to 37% of the population — are in a borderline zone called prehypertension. And that “precondition” carries its own risks of heart disease, stroke, and progression to full hypertension, today’s Informed Patient column reports.

As high blood pressure is increasingly identified as a risk factor for health problems including stroke, heart disease, kidney disease and even dementia, researchers are trying to find out more about prehypertension and how to address it. But the new medical designation has also sparked some contentious debates, which are expected to play out in February at the first international conference on prehypertension. One planned session is called “Is it Justified to Merge Normal and High Normal Blood Pressure into Prehypertension?” and there will also be a debate, “Prehypertension – Is it a Disease or Disease Invention?”

That kind of question has been swirling since 2003, when a federal panel, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, designated prehypertension as a new classification covering a range long considered “normal to high normal”: blood pressure between 120 and 139 millimeters of mercury systolic (the pressure at the moment the heart beats) or between 80 and 89 mm Hg diastolic (when the heart is at rest).

The committee did not suggest drug treatment for prehypertension, recommending only lifestyle modifications, such as weight loss and exercise. But after a 2006 study showed that blood-pressure drugs can reduce the progression to hypertension in prehypertensive patients, more physicians have been calling for pharmaceutical solutions.

In August of this year, an article in the British Medical Journal noted that in the wake of the new classification, prehypertension is emerging as a potential goldmine for drug companies, and pointed out that many physicians who were members of the committee have disclosed financial relationships to industry.

One of the committee members named in the article is George Bakris, director of the Hypertension Center at the University of Chicago, who has disclosed consulting arrangements with several drug companies. Bakris, for his part, tells the Health Blog that the committee’s decision had nothing to do with drug-company interests, and was meant to educate and empower patients.

At the time the committee was finalizing its recommendations, he says, new studies were showing that cardiovascular risk starts climbing at blood-pressure readings of 115/75, not 140/90. And starting at 115/75, the risk doubles for each 20 mm Hg increase in systolic pressure and each 10 mm Hg increase in diastolic pressure.

“Everyone wants to beat up on the term prehypertension, like saying it is pre-death, when we are all pre-death,” Bakris says. “But we know if we intervene in blood pressure we can buy back some lost lifetime for the patient, if we can get it under control.” After 55, there is a 90% chance that most people will become hypertensive if they aren’t already, he notes. “I tell patients the analogy is that if you know there is a fire in one room of your house, if you don’t do something about it, the house is going to burn down.”

By Laura Landro / WSJ