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Prehypertension

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Prehypertension
Other namesHigh normal blood pressure, borderline hypertensive (BH)
SpecialtyCardiology

Prehypertension, also known as high normal blood pressure and borderline hypertensive (BH),[1] is a medical classification for cases where a person's blood pressure is elevated above optimal or normal, but not to the level considered hypertension (high blood pressure). Prehypertension is now referred to as "elevated blood pressure" by the American College of Cardiology (ACC) and the American Heart Association (AHA).[2] The ACC/AHA define elevated blood pressure as readings with a systolic pressure from 120 to 129 mm Hg and a diastolic pressure under 80 mm Hg,[3] Readings greater than or equal to 130/80 mm Hg are considered hypertension by ACC/AHA and if greater than or equal to 140/90 mm Hg by ESC/ESH.[4] and the European Society of Hypertension defines "high normal blood pressure" as readings with a systolic pressure from 130 to 139 mm Hg and a diastolic pressure 85-89 mm Hg.[5]

Classification of blood pressure is based upon two or more readings at two or more separate occasions, and compared to out-of-office blood pressure readings if possible.[6][7]

Signs and symptoms

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Prehypertension is often asymptomatic (without symptoms) at the time of diagnosis. Only extremely elevated blood pressure (malignant hypertension) can, in rare cases, cause headaches, visual changes, fatigue, or dizziness, but these are nonspecific symptoms which can occur with many other conditions. Thus, blood pressures above normal can go undiagnosed for a long period of time.

Causes

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Elevated blood pressure develops gradually over many years usually without a specific identifiable cause. However, possible medical causes, such as medications, kidney disease, adrenal problems or thyroid problems, must first be excluded. High blood pressure that develops over time without a specific cause is considered benign or essential hypertension. Blood pressure also tends to increase as a person ages.

Management

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To lower the risk of prehypertension progressing to hypertension, modification of lifestyle or behaviors is necessary.

Lifestyle modifications

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Diet

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A low-sodium, high potassium diet is recommended, along with increasing physical activity to at least thirty minutes a day most days of the week, quitting smoking, reducing alcohol consumption, and maintaining a healthy weight.[8]

Specifically, a diet that is high in fruits and vegetables (aim for half of your meal including non-starchy vegetables, like leafy greens, beans, carrots, cucumbers, tomatoes, etc.), whole grains, low in refined grains (e.g., white breads and baked goods made from white flour), low in saturated fats ( e.g., fatty cuts of meat or fried foods) and low in sodium (homemade or minimally processed) have been demonstrated through randomized controlled studies to significantly lower blood pressure. These types of diet changes alone can lower blood pressure greater than any single drug therapy. The effects of both diet and sodium reduction work together, meaning the more you improve your diet to include less saturated fat and more fruits and vegetables OR lower your sodium intake significantly below what is typical in industrialized nations, like the United States, the greater the benefit will be seen. Similarly, the better the quality of diet, the more the results will be seen. Significant results have been seen in 30 days.[9]

Foods rich in potassium include banana, papaya, sweet potato, dark leafy greens, avocado, prune juice, tomato juice, oranges, milk, yogurt, dried beans such as navy, pinto and black beans, chickpeas, lentils, beef, pork, fish, nuts and seeds such as pistachio, almonds, pumpkin, flax and sunflower seeds.[10]

Exercise

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Exercise including aerobic exercise,[11][12]  isometric exercise,[11][12]  dynamic resistance training,[11][13] Tai Chi,[12]  Qigong,[12]  and Yoga[12][14]  can reduce blood pressure in prehypertensive individuals.

Sleep

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Lack of sleep can increase blood pressure, and longer sleep cycles may reduce blood pressure in prehypertensive individuals.[15]

Stress

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Stress reducing techniques can improve elevated blood pressure.[16]

Monitoring

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Careful monitoring for signs of end-organ damage or progression to hypertension is an important part of the follow-up of patients with prehypertension. Any change in blood pressure classification should be confirmed on at least one subsequent visit.

The major indication for pharmacologic antihypertensive therapy is progression to hypertension. The threshold is lower in patients with diabetes, chronic kidney failure, or cardiovascular disease.[17] The target blood pressure for these conditions is currently less than 120/80 mm Hg.

Home monitoring

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Home monitoring of blood pressure can be used to monitor and track prehypertensive patients. This can help to raise the awareness of the patient and his / her doctor if blood pressure levels rise to hypertensive levels. Home monitoring can help to avoid white coat hypertension which results in blood pressure levels being elevated due to the presence of a doctor or physician in a "white coat". Monitoring at home or work at regular times each day helps to diagnose a patient with prehypertension or hypertension.

The American Heart Association website[18] says, "You may have what's called 'white coat hypertension'; that means your blood pressure goes up when you're at the doctor's surgery. Monitoring at home will help you measure your true blood pressure and can provide your doctor with a log of blood pressure measurements over time. This is helpful in diagnosing and preventing potential health problems."

People using home blood pressure monitoring devices are increasingly also using blood pressure charting software. These charting methods provide print outs for the patient's physician and reminders to check blood pressure.

Medication

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Patients with other health conditions and elevated blood pressure, especially those with diabetes, kidney disease or heart disease, may be advised to take blood pressure medication.[19]

Prognosis

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The extent to which prehypertension constitutes a serious health concern remains controversial.[20] Several long-term studies have suggested no significant increase in all-cause mortality over long periods of time for individuals falling within the prehypertensive range.[21][22] Many studies further indicate a J-shaped relationship between blood pressure and mortality, whereby both very high and very low levels are associated with notable increases in mortality.[23] On the other hand, the National Heart, Lung, and Blood Institute suggests that people with prehypertension are at a higher risk for developing hypertension, or high blood pressure, compared to people with normal blood pressure.[24]

A 2014 meta-analysis concluded that prehypertension increases the risk of stroke, and that even low-range prehypertension significantly increases stroke risk[25] and a 2019 meta-analysis found elevated blood pressure increases the risk of heart attack by 86% and stroke by 66%.[26]

Epidemiology

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Data from the 1999 and 2000 National Health and Nutrition Examination Survey (NHANES III) estimated that the prevalence of prehypertension among adults in the United States was approximately 31 percent and decreased to 28 percent in the 2011–2012 National Health and Nutrition Examination Survey.[27] The prevalence was higher among men than women.[27]

Risk factors

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A primary risk factor for prehypertension is being overweight. Other risk factors include a family history of hypertension, a sedentary lifestyle, eating high sodium foods, smoking, and excessive alcohol or caffeine intake.[28]

See also

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References

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  1. ^ Logan, Carolynn M.; Rice, M. Katherine (1987). Logan's Medical and Scientific Abbreviations. J. B. Lippincott and Company. p. 58. ISBN 0-397-54589-4.
  2. ^ Whelton, Paul K.; Carey, Robert M.; Aronow, Wilbert S.; Casey, Donald E.; Collins, Karen J.; Dennison Himmelfarb, Cheryl; DePalma, Sondra M.; Gidding, Samuel; Jamerson, Kenneth A.; Jones, Daniel W.; MacLaughlin, Eric J.; Muntner, Paul; Ovbiagele, Bruce; Smith, Sidney C.; Spencer, Crystal C. (June 2018). "2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Hypertension. 71 (6): 1269–1324. doi:10.1161/HYP.0000000000000066. ISSN 1524-4563. PMID 29133354. S2CID 207581793.
  3. ^ Bakris, George; Ali, Waleed; Parati, Gianfranco (2019-06-18). "ACC/AHA Versus ESC/ESH on Hypertension Guidelines: JACC Guideline Comparison". Journal of the American College of Cardiology. 73 (23): 3018–3026. doi:10.1016/j.jacc.2019.03.507. ISSN 1558-3597. PMID 31196460. S2CID 189814197.
  4. ^ Whelton, Paul K.; Carey, Robert M.; Mancia, Giuseppe; Kreutz, Reinhold; Bundy, Joshua D.; Williams, Bryan (2022-09-13). "Harmonization of the American College of Cardiology/American Heart Association and European Society of Cardiology/European Society of Hypertension Blood Pressure/Hypertension Guidelines: Comparisons, Reflections, and Recommendations". Circulation. 146 (11): 868–877. doi:10.1161/CIRCULATIONAHA.121.054602. ISSN 1524-4539. PMID 35950927. S2CID 251494382.
  5. ^ Mancia, Giuseppe; Kreutz, Reinhold; Brunström, Mattias; Burnier, Michel; Grassi, Guido; Januszewicz, Andrzej; Muiesan, Maria Lorenza; Tsioufis, Konstantinos; Agabiti-Rosei, Enrico; Algharably, Engi Abd Elhady; Azizi, Michel; Benetos, Athanase; Borghi, Claudio; Hitij, Jana Brguljan; Cifkova, Renata (2023). "2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA)". Journal of Hypertension. 41 (12): 1874–2071. doi:10.1097/HJH.0000000000003480. hdl:11379/603005. ISSN 0263-6352.
  6. ^ Whelton, Paul K.; Carey, Robert M.; Aronow, Wilbert S.; Casey, Donald E.; Collins, Karen J.; Dennison Himmelfarb, Cheryl; DePalma, Sondra M.; Gidding, Samuel; Jamerson, Kenneth A.; Jones, Daniel W.; MacLaughlin, Eric J.; Muntner, Paul; Ovbiagele, Bruce; Smith, Sidney C.; Spencer, Crystal C. (June 2018). "2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Hypertension. 71 (6): e13–e115. doi:10.1161/HYP.0000000000000065. ISSN 1524-4563. PMID 29133356. S2CID 34986818.
  7. ^ Williams, Bryan; Mancia, Giuseppe; Spiering, Wilko; Agabiti Rosei, Enrico; Azizi, Michel; Burnier, Michel; Clement, Denis L.; Coca, Antonio; de Simone, Giovanni; Dominiczak, Anna; Kahan, Thomas; Mahfoud, Felix; Redon, Josep; Ruilope, Luis; Zanchetti, Alberto (2018-09-01). "2018 ESC/ESH Guidelines for the management of arterial hypertension". European Heart Journal. 39 (33): 3021–3104. doi:10.1093/eurheartj/ehy339. ISSN 1522-9645. PMID 30165516.
  8. ^ Svetkey, Laura P. (June 2005). "Management of prehypertension". Hypertension. 45 (6): 1056–1061. doi:10.1161/01.HYP.0000167152.98618.4b. ISSN 1524-4563. PMID 15897368.
  9. ^ Sacks, F. M.; Svetkey, L. P.; Vollmer, W. M.; Appel, L. J.; Bray, G. A.; Harsha, D.; Obarzanek, E.; Conlin, P. R.; Miller, E. R.; Simons-Morton, D. G.; Karanja, N.; Lin, P. H.; DASH-Sodium Collaborative Research Group (2001-01-04). "Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group". The New England Journal of Medicine. 344 (1): 3–10. doi:10.1056/NEJM200101043440101. ISSN 0028-4793. PMID 11136953.
  10. ^ "Functions and Food Sources of Common Minerals". Dietitians of Canada. 2011-11-03. Archived from the original on 2017-01-18. Retrieved 2017-07-02.
  11. ^ a b c Cornelissen, Veronique A.; Smart, Neil A. (2013-02-01). "Exercise training for blood pressure: a systematic review and meta-analysis". Journal of the American Heart Association. 2 (1): e004473. doi:10.1161/JAHA.112.004473. ISSN 2047-9980. PMC 3603230. PMID 23525435.
  12. ^ a b c d e Fu, Jinming; Liu, Yupeng; Zhang, Lei; Zhou, Lu; Li, Dapeng; Quan, Hude; Zhu, Lin; Hu, Fulan; Li, Xia; Meng, Shuhan; Yan, Ran; Zhao, Suhua; Onwuka, Justina Ucheojor; Yang, Baofeng; Sun, Dianjun (2020-09-25). "Nonpharmacologic Interventions for Reducing Blood Pressure in Adults With Prehypertension to Established Hypertension". Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease. 9 (19): e016804. doi:10.1161/JAHA.120.016804. ISSN 2047-9980. PMC 7792371. PMID 32975166.
  13. ^ Abrahin, Odilon; Moraes-Ferreira, Renilson; Cortinhas-Alves, Erik Artur; Guerreiro, João Farias (September 2021). "Is resistance training alone an antihypertensive therapy? A meta-analysis". Journal of Human Hypertension. 35 (9): 769–775. doi:10.1038/s41371-021-00582-9. ISSN 1476-5527. PMID 34321596. S2CID 236460936.
  14. ^ Khandekar, Janhavi Sandeep; Vasavi, Vanamala Lakshmi; Singh, Vijay Pratap; Samuel, Stephen Rajan; Sudhan, S. G.; Khandelwal, Bidita (2021-09-13). "Effect of Yoga on Blood Pressure in Prehypertension: A Systematic Review and Meta-Analysis". The Scientific World Journal. 2021: 4039364. doi:10.1155/2021/4039364. ISSN 2356-6140. PMC 8452415. PMID 34552393.
  15. ^ Makarem, Nour; Shechter, Ari; Carnethon, Mercedes R.; Mullington, Janet M.; Hall, Martica H.; Abdalla, Marwah (2019-04-05). "Sleep Duration and Blood Pressure: Recent Advances and Future Directions". Current Hypertension Reports. 21 (5): 33. doi:10.1007/s11906-019-0938-7. ISSN 1534-3111. PMC 10239254. PMID 30953237. S2CID 96450039.
  16. ^ Geiger, Christoph; Cramer, Holger; Dobos, Gustav; Kohl-Heckl, Wiebke Kathrin (2022-10-10). "A systematic review and meta-analysis of mindfulness-based stress reduction for arterial hypertension". Journal of Human Hypertension. 37 (3): 161–169. doi:10.1038/s41371-022-00764-z. ISSN 1476-5527. PMID 36216879. S2CID 252816575.
  17. ^ Sipahi I, Tuzcu EM, Schoenhagen P, et al. (August 2006). "Effects of normal, pre-hypertensive, and hypertensive blood pressure levels on progression of coronary atherosclerosis". J. Am. Coll. Cardiol. 48 (4): 833–8. doi:10.1016/j.jacc.2006.05.045. PMID 16904557.
  18. ^ American Heart Association website
  19. ^ "Elevated Blood Pressure". Mayo Clinic dated August 9, 2022. Retrieved December 19, 2022.
  20. ^ Smetana, GW (2011). "Rethinking "Abnormal" Blood Pressure: What is the Value?". Journal of General Internal Medicine. 26 (7): 678–680. doi:10.1007/s11606-011-1737-2. PMC 3138596. PMID 21557032.
  21. ^ Taylor, BC; Wilt, TJ; Welch, HG (2011). "Impact of diastolic and systolic blood pressure on mortality: Implications for the definition of "normal"". Journal of General Internal Medicine. 26 (7): 685–90. doi:10.1007/s11606-011-1660-6. PMC 3138604. PMID 21404131.
  22. ^ Port, S; Demer, L; Jennrich, R; Walter, D; Garfinkel, A (2000). "Systolic blood pressure and mortality". Lancet. 355 (9199): 175–80. doi:10.1016/S0140-6736(99)07051-8. PMID 10675116. S2CID 54309252.
  23. ^ Messerli, Franz H.; Panjrath, Gurusher S. (2009). "The J-Curve Between Blood Pressure and Coronary Artery Disease or Essential Hypertension". Journal of the American College of Cardiology. 54 (20): 1827–1834. doi:10.1016/j.jacc.2009.05.073. PMID 19892233.
  24. ^ National Heart, Lung and Blood Institute<"What Are High Blood Pressure and Prehypertension?". Archived from the original on 2011-10-31. Retrieved 2011-11-04.>
  25. ^ Huang, Y; Cai X; Li Y; Su L; Mai W; Wang S; Hu Y; Wu Y; Xu D. (Mar 12, 2014). "Prehypertension and the risk of stroke: A meta-analysis". Neurology. 82 (13): 1153–61. doi:10.1212/WNL.0000000000000268. PMID 24623843. S2CID 2414005.
  26. ^ Han, Minghui; Li, Quanman; Liu, Leilei; Zhang, Dongdong; Ren, Yongcheng; Zhao, Yang; Liu, Dechen; Liu, Feiyan; Chen, Xu; Cheng, Cheng; Guo, Chunmei; Zhou, Qionggui; Tian, Gang; Qie, Ranran; Huang, Shengbing (December 2019). "Prehypertension and risk of cardiovascular diseases: a meta-analysis of 47 cohort studies". Journal of Hypertension. 37 (12): 2325–2332. doi:10.1097/HJH.0000000000002191. ISSN 1473-5598. PMID 31335511. S2CID 198191212.
  27. ^ a b Booth, John N.; Li, Jiexiang; Zhang, Lu; Chen, Liwei; Muntner, Paul; Egan, Brent (August 2017). "Trends in Prehypertension and Hypertension Risk Factors in US Adults: 1999-2012". Hypertension. 70 (2): 275–284. doi:10.1161/HYPERTENSIONAHA.116.09004. ISSN 1524-4563. PMC 5594566. PMID 28607131.
  28. ^ "Know Your Risk for High Blood Pressure". Centers for Disease Control and Prevention. 2020.
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