Care Coordination Institute and Department of Medicine, University of South Carolina School of Medicine-Greenville, 300 East McBee Avenue, Suite 401, Greenville, SC 29601, USA.
Nat Rev Cardiol. 2015 May;12(5):289-300. doi: 10.1038/nrcardio.2015.17. Epub 2015 Feb 17.
Prehypertension (blood pressure 120-139/80-89 mmHg) affects ~25-50% of adults worldwide, and increases the risk of incident hypertension. The relative risk of incident hypertension declines by ~20% with intensive lifestyle intervention, and by 34-66% with single antihypertensive medications. To prevent one case of incident hypertension in adults with prehypertension and a 50% 5-year risk of hypertension, 10 individuals would need to receive intensive lifestyle intervention, and four to six patients would need to be treated with antihypertensive medication. The relative risk of incident cardiovascular disease (CVD) is greater with 'stage 2' (130-139/85-89 mmHg) than 'stage 1' (120-129/80-84 mmHg) prehypertension; only stage 2 prehypertension increases cardiovascular mortality. Among individuals with prehypertension, the 10-year absolute CVD risk for middle-aged adults without diabetes mellitus or CVD is ~10%, and ~40% for middle-aged and older individuals with either or both comorbidities. Antihypertensive medications reduce the relative risk of CVD and death by ~15% in secondary-prevention studies of prehypertension. Data on primary prevention of CVD with pharmacotherapy in prehypertension are lacking. Risk-stratified, patient-centred, comparative-effectiveness research is needed in prehypertension to inform an acceptable, safe, and effective balance of lifestyle and medication interventions to prevent incident hypertension and CVD.
高血压前期（血压 120-139/80-89mmHg）影响全球约 25-50%的成年人，且增加了高血压发病风险。强化生活方式干预可使高血压发病风险降低约 20%，单一降压药物治疗可使发病风险降低 34-66%。为了预防高血压前期患者发生高血压，且 5 年内有 50%的高血压发病风险，需要对 10 名患者进行强化生活方式干预，需要对 4 至 6 名患者进行降压药物治疗。与“1 期”高血压前期（120-129/80-84mmHg）相比，“2 期”高血压前期（130-139/85-89mmHg）发生心血管疾病（CVD）的相对风险更高；仅 2 期高血压前期增加心血管死亡率。在高血压前期患者中，无糖尿病或 CVD 的中年成年人 10 年内 CVD 绝对风险约为 10%，有或无合并症的中年和老年成年人 CVD 绝对风险约为 40%。降压药物治疗可使高血压前期二级预防研究中 CVD 和死亡的相对风险降低约 15%。缺乏高血压前期患者采用药物治疗进行 CVD 一级预防的数据。需要在高血压前期中进行风险分层、以患者为中心、比较疗效的研究，以了解可接受、安全且有效的生活方式和药物干预措施之间的平衡，从而预防高血压和 CVD 发病。
