Should the results of TROPHY affect the JNC 7 definition of prehypertension?
In the Trial of Preventing Hypertension (TROPHY), volunteers with "high normal blood pressure" were randomized to 4 years of placebo (n = 381) or 2 years of 16 mg/d of candesartan (n = 391) followed by 2 years of placebo. At 2 years, there was a 26.8% absolute and a 66.3% relative risk reduction (P < 0.0001) of hypertension in the candesartan group. At study end, the former candesartan group had a 9.8% absolute and a 15.6% relative risk reduction (P < 0.007) of hypertension. The treatment was well tolerated. The Seventh Joint National Committee (JNC 7) changed the nomenclature from "high normal blood pressure" to "prehypertension" and widened the range to 120 to 139 and/or 80 to 89 mm Hg. Our results support the term "prehypertension" only for the 130 to 139 and/or 85 to 89 mm Hg group; in 4 years two thirds of the placebo group developed hypertension. We suggest stratifying the JNC classification into "prehypertension" (130-139 and/or 85-89 mm Hg) and "high normal blood pressure" (120-129 and/or 80-84 mm Hg). By the present JNC definition, only one quarter of adult men have normal blood pressure. Removing the disease label from another 28% would appropriately focus attention on high-risk prehypertension.
Julius
Stevo
S
Internal 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
D026683:Advisory Committees; D000959:Antihypertensive Agents / Q000592:standards / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000592:standards / Q000627:therapeutic use; D001713:Biphenyl Compounds; D001794:Blood Pressure / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D040242:Risk Reduction Behavior; D013777:Tetrazoles / Q000592:standards / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan