Is it time to treat prehypertension?

Prehypertension, defined as blood pressure between 120-139/80-89 mmHg, is a major public health concern. The condition is very prevalent (30% of the adult population), is often associated with other cardiovascular risk factors and independently increases the risk of hypertension and subsequent cardiovascular events. The mechanism of elevated risk for cardiovascular events associated with prehypertension is presumed to be the same as that of hypertension. In the general population, prehypertension can be lowered by lifestyle modifications, but often not reliably. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) recommendation for prehypertension management with optimal weight control (largely through diet and exercise) remains the mainstay, except for individuals with diabetes, chronic kidney disease, and perhaps known coronary artery disease, because of the shot-term cost considerations and unproven long-term prognosis. The recently published Trial of Preventing Hypertension (TROPHY) is the first study of pharmacologic intervention among those with prehypertension. Results from this trial demonstrated that angiotensin receptor blockade (ARB) retards age-related blood pressure increases in prehypertensive patients. In this review, we discuss the options for pharmacologic intervention of prehypertension, with a focus on the TROPHY trial results.