Weighing Prehypertension Treatment Options

Left untreated, high blood pressure has long-term health consequences

By David Dunaief, M.D.

We have focused a large amount of effort on the treatment and prevention of hypertension (high blood pressure) in the U.S. This insidious disorder includes prehypertension —defined as a systolic blood pressure (the top number) of 120-139 mmHg and/or a diastolic blood pressure (the bottom number) of 80-89 mmHg. Prehypertension is pervasive in the United States, affecting approximately one-third of people (1).

The consequences of prehypertension are significant, even though there are often no symptoms. For example, it increases the risk of cardiovascular disease and heart attack dramatically: in an analysis of the Framingham Heart Study, researchers found a 3.5-fold increase in the risk of heart attack and a 1.7-fold increase in the risk of cardiovascular disease among those with prehypertension (2). This is why it’s crucial to treat it in these early stages, even before it reaches the level of hypertension.

Another study, the Women’s Health Initiative, which followed more than 60,000 postmenopausal women for an average of 7.7 years, showed an increase in heart attack deaths, heart attacks and strokes compared to those with normal blood pressure (less than 120/80 mmHg). In the Strong Heart Study, prehypertension independently increased the risk for cardiovascular events at 12 years significantly (3).

Furthermore, according to the Framingham Heart Study, the risk of sustained hypertension increases substantially the higher the baseline blood pressure (4).

This may or may not impact mortality, but it certainly does impact morbidity (sickness). Quality of life may be dramatically reduced with heart disease, heart attack and hypertension.

Treatment of prehypertension

In my view, it would be foolish not to treat prehypertension. Recommendations for treatment, according to the Joint National Commission (JNC) 7, the association responsible for guidelines on the treatment of prehypertension and hypertension, are lifestyle modifications (5). These involve a Mediterranean-type diet called DASH (Dietary Approaches to Stop Hypertension), with a focus on fruits, vegetables, reduction in sodium to a maximum of 1,500 mg (⅔ of a teaspoon on a daily basis), exercise, weight loss and no more than moderate amounts of alcohol (1 or fewer drinks for women and 2 or fewer drinks for men on a daily basis).

Some studies have also shown that a diet rich in potassium helps to reduce blood pressure (6). Fortunately, foods like fruits, vegetables, beans and legumes have significant amounts of potassium. However, do not take potassium supplements unless instructed for other reasons by a physician; high potassium can be very dangerous and may precipitate a heart attack.

The danger in treating prehypertension comes only when medication is used, due to side effects.

Unfortunately, the Trial of Preventing Hypertension (TROPHY) suggests the use of a hypotensive agent, the blood pressure drug Atacand (candesartan) to treat prehypertensive patients (7). The drug reduced the incidence of hypertension significantly compared to placebo over two years. However, after stopping therapy, the following two years showed only a small benefit over placebo. Yet the authors implied that this may be a plausible treatment. The study was funded by Astra-Zeneca, the makers of the drug.

In an editorial, Dr. Jay I. Meltze, a clinical specialist in hypertension at Columbia University’s College of Physicians and Surgeons, noted that the results were interpreted in an unusually favorable way (8).

Prehypertension is an asymptomatic disorder that has been shown to respond well to lifestyle changes — why create symptoms with medication? Therefore, I don’t recommend treating prehypertension patients with medication. Thankfully, the JNC7 agrees.

However, it should be treated -— and treated with lifestyle modifications. The side effects from this approach are only better overall health. Please get your blood pressure checked at least on an annual basis.

References:

(1) cdc.gov. (2) Stroke 2005; 36: 1859–1863. (3) Hypertension 2006;47:410-414. (4) Lancet 2001;358:1682-6. (5) nhlbi.nih.gov. (6) Archives of Internal Medicine 2001;161:589-593. (7) N Engl J Med. 2006;354:1685-1697. (8) Am J Hypertens. 2006;19:1098-1100.

Dr. David Dunaief is a speaker, author and lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.

This article was originally published in TBR News Media. www.tbrnewsmedia.com.