title: Preventing the progression of prehypertension to hypertension: role of antihypertensives.
abstract: Recent guidelines for the diagnosis and management of hypertension reversed the historical trend to recommend lower blood pressure (BP) thresholds to diagnose hypertension in high-risk individuals, such as patients with diabetes and elderly patients. The decision to raise the BP thresholds for diagnosis of hypertension in patients with diabetes was mostly based on the findings of the ACCORD trial. Nonetheless, the results of the ACCORD trial are within the predicted benefit to prevent coronary artery disease and stroke by meta-analysis of randomized controlled trials (RCT), particularly in regard to the prevention of stroke. The Eighth Joint National Committee (JNC 8) did not address prehypertension. There are many RCT done in individuals with prehypertension and concomitant cardiovascular disease showing the benefit of treatment of these patients. Trials exploring the efficacy of interventions to prevent cardiovascular disease in individuals with prehypertension free of cardiovascular disease would be hardly feasible in face of the low absolute risk of these individuals. Considering the risks of prehypertension for cardiovascular disease and the fast progression to hypertension of a large proportion of individuals with prehypertension, it is worth to consider drug treatment for individuals with prehypertension. RCT showed that the progression to hypertension can be partially halted by BP-lowering agents. These and ongoing clinical trials are herein revised. Prehypertension may be a window of opportunity to prevent hypertension and its cardiovascular consequences.
authors.affiliation: Division of Cardiology, Hospital de Clínicas de Porto Alegre, UFRGS, Ramiro Barcelos 2350, Sala 2060, 90035-903, Porto Alegre, Brazil, ffuchs@hcpa.ufrgs.br.
authors.forename: Flávio Danni
authors.initials: FD
authors.lastname: Fuchs
authors.forename: Renato Bandeira
authors.initials: RB
authors.lastname: de Mello
authors.forename: Sandra Costa
authors.initials: SC
authors.lastname: Fuchs
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D018450:Disease Progression; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000517:prevention & control*; D058246:Prehypertension / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000959:Antihypertensive Agents