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Pre-hypertension: rationale for pharmacotherapy
Brent M Egan1, Marilyn A Laken
1School of Medicine Greenville, Greenville Health System, Care Coordination Institute, University of South Carolina, Greenville, SC, USA, began@carecoordinationinstitute.org.
Insights
Pre-hypertension significantly elevates risks for hypertension and cardiovascular events. Clinical trials in African Americans are needed to address racial disparities in hypertension and improve health equity.
Area of Science:
- Cardiology
- Public Health
- Health Disparities
Background:
- Pre-hypertension (blood pressure 120-139/80-89 mmHg) affects millions in the US, with elevated readings increasing risks for hypertension and cardiovascular events.
- Current guidelines recommend lifestyle interventions for pre-hypertension, but population effectiveness is limited by lifestyle factors.
- African Americans experience a faster progression from pre-hypertension to hypertension compared to Caucasians, highlighting a significant health disparity.
Purpose of the Study:
- To investigate the potential of antihypertensive medications in treating pre-hypertension.
- To explore the feasibility and merit of clinical trials targeting African Americans with pre-hypertension.
- To provide a foundation for guidelines aimed at reducing racial disparities in hypertension and related diseases.
Main Methods:
- Review of existing evidence on pre-hypertension risks and interventions.
- Analysis of racial differences in hypertension progression.
- Proposal for targeted clinical trials in African American populations.
Main Results:
- Individuals with pre-hypertension face significantly higher risks of developing hypertension and cardiovascular issues.
- Antihypertensive medications can be safely used to reduce incident hypertension in pre-hypertensive individuals.
- Racial disparities exist in the transition from pre-hypertension to hypertension, with African Americans progressing more rapidly.
Conclusions:
- Clinical trials in African Americans with pre-hypertension are warranted to address and eliminate racial disparities in hypertension.
- Effective interventions could improve racial equity in hypertension prevalence and reduce associated cardiovascular and renal complications.
- Evidence supports the use of antihypertensive medications for individuals with pre-hypertension to mitigate risks.
Abstract:
Pre-hypertension, defined as blood pressure 120-139/80-89 mmHg, affects ~70 million people in the US. Blood pressures in the upper half of the pre-hypertensive range are linked with roughly threefold greater risk of incident hypertension than normal blood pressure <120/<80 mmHg, with an incidence rate of 8-20 % annually. Blood pressures in the upper half of the pre-hypertensive range also roughly double risk for cardiovascular events, even in the absence of progression to hypertension. Despite excess risk, guidelines recommend lifestyle interventions only for people with pre-hypertension in the absence of diabetes mellitus or clinical cardiovascular or chronic kidney disease. While efficacious, lifestyle changes have limited population effectiveness as Americans are heavier and their nutritional patterns less DASH-like than before DASH was published. Prevalent hypertension is higher in African Americans than Caucasians, but prevalent pre-hypertension is similar. African Americans experience a more rapid transition from pre-hypertension to hypertension than Caucasians with pre-hypertension. Interventions that normalize racial differences in incident hypertension could, over time, improve racial equity in prevalent hypertension and related clinical complications. Individuals with pre-hypertension can be safely treated with antihypertensive medications to significantly reduce incident hypertension. Given the evidence, practical clinical trials in African Americans with pre-hypertension to reduce and eliminate racial disparities in incident hypertension have merit. The results of these trials could provide the foundation for clinical guidelines to reduce racial disparities in prevalent hypertension and associated clinical cardiovascular and renal diseases.
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