How to Define Prehypertension in Diabetes/Metabolic Syndrome
- Avshalom Leibowitz, MD and
- Ehud Grossman, MD
- From the Internal Medicine Department D and the Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Corresponding author: Ehud Grossman, grosse{at}post.tau.ac.il.
Hypertension is a powerful risk factor for cardiovascular (CV) morbidity and mortality. The coexistence of hypertension and type 2 diabetes is devastating to the CV system (1). Lowering blood pressure (BP) is especially beneficial in diabetic patients, and therefore the goal BP in these patients is <130/80 mmHg rather than 140/90 mmHg, which is the goal in the general population (2,3). The Joint National Committee (JNC) VII introduced the term “prehypertension,” which is defined as BP levels of 120–139 mmHg for systolic and 80–89 mmHg for diastolic BP, respectively (2). Because the goal BP in diabetic patients and in those with metabolic syndrome is <130/80 mmHg, the question arises as to what the definition of prehypertension should be in these patients. The present review analyzes the available data to determine how to define prehypertension in diabetes/metabolic syndrome.
TYPE 2 DIABETES AND CV RISK
Despite the advances in CV medicine over the past decades, cardiovascular disease (CVD) remains the major cause of mortality and morbidity in the western world. A similar tendency has been observed over recent years in the developing world as well, where the prevalence of CVD is consistently on the increase. Although multiple factors are responsible for these phenomena, the recent rise in prevalence of type 2 diabetes is significant.
Up to two-thirds of all deaths in diabetic patients are due to a CV event. The high CVD risk of diabetic patients was shown in several studies. The San Antonio Heart Study demonstrated that type 2 diabetes increased CV mortality by about threefold in men (relative risk [RR] 3.2 [95% CI 1.4–7.1]) and by approximately eightfold in women (RR 8.5 [2.8–25.2]) (4). Data from the Framingham longitudinal study showed that type 2 diabetes increases the risk for developing congestive heart failure (CHF) by 1.8-fold in men and 3.7-fold in women (5). Because …
