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Should the results of TROPHY affect the JNC 7 definition of prehypertension?

Stevo Julius1

  • 1Internal Medicine and Physiology, Division of Cardiovascular Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby M, 3rd Floor, Ann Arbor, MI 48106, USA. sjulius@umich.edu

Current Hypertension Reports
|May 24, 2007
PubMed

Insights

Candesartan significantly reduced hypertension risk in individuals with high normal blood pressure. Researchers suggest refining "prehypertension" categories for better risk stratification.

Area of Science:

  • Cardiovascular Medicine
  • Clinical Pharmacology
  • Hypertension Research

Background:

  • The Trial of Preventing Hypertension (TROPHY) investigated interventions for individuals with high normal blood pressure.
  • The Seventh Joint National Committee (JNC 7) redefined this category as 'prehypertension' (120-139 and/or 80-89 mm Hg).

Purpose of the Study:

  • To evaluate the efficacy of candesartan in preventing hypertension in subjects with high normal blood pressure.
  • To propose a refined classification for prehypertension based on observed outcomes.

Main Methods:

  • Randomized, placebo-controlled trial involving volunteers with high normal blood pressure.
  • Intervention group received candesartan (16 mg/d) for 2 years, followed by placebo for 2 years.
  • Control group received placebo for 4 years.

Main Results:

  • Candesartan significantly reduced the risk of developing hypertension by 66.3% at 2 years (P < 0.0001).
  • The former candesartan group showed a 15.6% relative risk reduction in hypertension by study end (P < 0.007).
  • Two-thirds of the placebo group developed hypertension over 4 years.

Conclusions:

  • Candesartan is effective in preventing hypertension in individuals with high normal blood pressure.
  • The study supports stratifying 'prehypertension' into 'high-risk prehypertension' (130-139 and/or 85-89 mm Hg) and 'high normal blood pressure' (120-129 and/or 80-84 mm Hg).
  • Refined classification can better focus attention on individuals at higher risk of developing hypertension.

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