MRCGP exam update Prehypertension

Current situation

Research has shown the benefits of patients with 'prehypertension' being treated with medication to lower their BP.

Individuals with prehypertension or high normal BP - BP 130 to 139/85 to 89mmHg - are at increased risk of cardiovascular disease and MI.

What is the evidence?
Compared with patients who had optimal BP, the relative risk of developing cardiovascular disease has been found to be 2.49 for those with prehypertension, after adjustment for recognised cardiovascular risk factors (Am J Med 2006; 119: 133-41).

Metabolic syndrome, obesity, overweight and elevated triglycerides to HDL ratio have been shown to be independent risk factors for the progression from normotension to prehypertension (Am J Hypertens 2006; 19: 189-96).

Analysis of the Women's Health Initiative showed prehypertension is associated with increased risk of MI in postmenopausal women (Circulation 2007; 115: 855-60).

One study has shown that women with prehypertension have a much higher risk for developing hypertension or a major cardiovascular event than women with normal BP (BMJ 2007; 335: 432-5).

Another study has demonstrated that prehypertension doubles the risk for diabetes and CHD in women (Am J Hypertens 2008 doi:10.1038/ajh.2008.212).

Giving patients with prehypertension candesartan for two years reduced the risk of progression to hypertension by 66 per cent (N Engl J Med 2006; 354: 1,685-97).

Implications for practice
Patients with prehypertension are more likely to develop hypertension compared with those with normal BP.

Guidelines
The current British Hypertension Society guidelines state people with 'high normal' BP should be measured annually.

Dr Louise Newson is a GP in the West Midlands and author of 'Hot Topics for MRCGP and General Practitioners', Pas Test 2006

Prehypertension points

  • Prehypertension is a risk factor for cardiovascular disease.
  • Candesartan may have a role in the management of prehypertension.
  • Prehypertension is very prevalent in diabetics.
  • Women with prehypertension seem to have greater risks than men.

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