Prehypertension is associated with increased risk for cardiovascular disease, according to a study from researchers with the Medical University of South Carolina.

These findings support the latest recommendations from the Joint National Commission on Prevention, Detection, Evaluation, and treatment of High Blood Pressure (JNC 7), which added prehypertension as a new risk category.

The expert panel recommended lifestyle modifications for all prehypertensive people, defined as those with systolic blood pressure levels between 120 and 139 mm Hg, or diastolic blood pressure levels between 80 and 90 mm Hg.

Analyzing nationally-representative data with 18 years of follow-up, researchers found that people with prehypertension are 1.79 times as likely to have a major cardiovascular event than those with normal blood pressure.

Even after adjustment for cardiovascular risk factors, researchers found that the relationship between prehypertension and cardiovascular disease persists with a 1.32 times greater risk of major cardiovascular event over normal blood pressure.

The authors assert that these findings support recommendations for physicians to actively target lifestyle modifications and multiple risk reduction in their prehypertensive patients. Epidemiologic data from the 1999-2000 National Health and Nutrition Examination Survey estimates that 31 percent of the population is prehypertensive and more than 88 percent of these people have a least one major cardiovascular risk factor.

An accompanying editorial to this article considers the study's implications along with the recent recommendations of the JNC 7 for practicing physicians.

The editorial asserts that given the risk associated with prehypertension and its increasing prevalence in practice, primary care physicians must think about how they practice when it comes to blood pressure and what might need to be done beyond clinical practices to work with patients on making healthy lifestyle changes.

Prehypertension and Cardiovascular Morbity
By Heather Liszka, M.D., et al

Prehypertension, Patient Outcomes, and the Knowledge Base of Family Medicine
By Lee Green, M.D., M.P.H.

Annals of Family Medicine is a peer-reviewed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care discipline. Launched in May 2003, the journal is sponsored by six family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors and the North American Primary Care Research Group. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. A board of directors with representatives from each of the sponsoring organizations oversees Annals. Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal's Web site, aafp.

Kristin Robinson
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American Academy of Family Physicians
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Taken from the July/August 2005 Annals of Family Medicine tip sheet