Treatment of Prehypertension in Diabetes and Metabolic Syndrome

What are the pros?

In 2003, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) published its ultimate guidelines for hypertension prevention and management (1). One of the key messages was the definition of a new category of blood pressure (BP) levels, i.e., prehypertension, that included individuals with a systolic BP of 120–139 mmHg or a diastolic BP of 80–89 mmHg. Patients with prehypertension were considered at increased risk for progression to hypertension and individuals in the 130/80 to 139/89 mmHg range were at twice the risk of developing hypertension than subjects with lower values (2). In the same year, the European Society of Hypertension and the European Society of Cardiology (ESH-ESC) published their guidelines for the management of arterial hypertension and, for the same range of BP, two different categories of BP were defined: normal BP (systolic BP of 120–129 mmHg, or diastolic BP of 80–84 mmHg) and high-normal BP (systolic BP of 130–139 mmHg, or diastolic BP of 85–89 mmHg) (3).

In 2007, the ESH-ESC committee decided against using the term “prehypertension” for several reasons (4). First, even in the Framingham study, the risk of developing hypertension was definitely higher in subjects with high-normal BP than in patients with normal BP (2,5), and therefore there is little reason to combine the two groups. Second, given the ominous significance of the word “hypertension” for the layman, the term “prehypertension” may, in many subjects, create anxiety and a request for unnecessary medical visits and examinations. Finally, although lifestyle changes recommended by the 2003 JNC VII guidelines for all prehypertensive individuals may be a valuable population strategy (1), in practice, this category is a highly differentiated one, with the extremes consisting of subjects with no need of any intervention (e.g., an …