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Prehypertension was defined in a 2004 report
from the Joint National Commission on High blood Pressure (JNC 7) as a
condition existing before a diagnosis of hypertension or high blood
pressure may be made.
Little was heard of the condition until studies in the last couple of
years showed there was a definite increased risk of developing “full
blown” hypertension in those of us with Prehypertension. Now,
Prehypertension is finally getting some attention in both medical
literature and the general press.
Why is Prehypertension considered so important?
Prehypertension is another one of what I call the “Pre” diseases. In
other words, it exists and can be detected before the disease, in this
case hypertension, actually is clearly diagnosable.
Unfortunately, Prehypertension has been associated with an increased
risk of cardiovascular disease, such as heart attack (myocardial
infarct) and stroke (cerebrovascular accidents).
Just like Pre-diabetes, we think that treating Prehypertension will help
a person either completely avoid having high blood pressure, or will
make it less severe once it occurs. Obviously, if we don’t develop high
blood pressure, we also will have less of a chance of suffering the side
effects of the disease.
How is Prehypertension diagnosed?
The condition Prehypertension is felt to exist when a person has an
adult blood pressure of 120 to 139 systolic or 80 to 89 diastolic.
(Either reading can be used to define the condition! It does not require
both to be elevated.)
“Low Prehypertension” exists with blood pressures of 120 to 129 systolic
or 80 to 84 diastolic.
What other factors or conditions are considered to be bad when
combined with Prehypertension?
-Physical inactivity
-Waist circumference of 36 inches or greater
-body mass index of 30 or greater
-Male gender
-Black race
-Age over 55 years
-Tobacco use
-Elevated cholesterol
-Previous history of heart disease, kidney disease or Diabetes
What are the side effects of hypertension or high blood pressure?
-Premature hardening of arteries (plaque formation)
-Damage to blood vessels in your kidneys
-Damage to blood vessels of the eyes
-Heart attack
-Stroke (sometimes starts as mini-strokes)
-Damage to blood vessels in the brain (not causing stroke) resulting in
memory loss or dementia
I describe high blood pressure by asking patients to think about what
happens to a balloon that is over-stretched by too much air pressure as
it is blown up. The balloon is just like a blood vessel in that it is
damaged by putting too much air in it.
What can you do to prevent Prehypertension from advancing to full
blown high blood pressure?
The treatment of Prehypertension involves lifestyle changes and
medications are usually not added unless the disease becomes associated
with another high risk condition such as Diabetes Mellitus or Kidney
disease.
So, what are lifestyle changes?
-Eating a healthy balanced low salt (low sodium) diet
-Losing weight to what is considered ideal for you (BMI=25 or less)
-Exercising 30 minutes on at least three days of the week
-Avoiding cigarettes and excessive alcohol
For those of us who need to lose weight, the DASH diet (Dietary Approach
to Stop Hypertension) represents a healthy lifestyle change in diet
designed to help a person work toward their ideal body weight.
What happens if lifestyle changes don’t result in a reduction in my
blood pressure?
Your doctor will probably begin therapy with a blood pressure medication
such as a diuretic or fluid pill and ask you to consider a more vigorous
exercise program and stricter diet.
Of course, the goal in treating Prehypertension, as we discussed above,
is to either totally avoid developing full blown high blood pressure or
make it less likely you would develop all the bad side effects of
hypertension.
Dr. Frank
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