Common Medical Conditions

Screening For Prehypertension

Written by
Dr. Naresh Kumar Monigari
and medically reviewed by iCliniq medical review team.

Published on Jun 02, 2016 and last reviewed on Sep 07, 2018   -  3 min read

Abstract

Abstract

Prehypertension is a known risk factor for cardiovascular and cerebrovascular problems, but the awareness is lacking among the population. Screening is essential as only with lifestyle modifications as many complications can be prevented.

Screening For Prehypertension

Many patients get to know their raised blood pressure at the time of diagnosis of heart attack, stroke or kidney disease (end organ failure), which would have been prevented if treated at an early stage. People diagnosed with hypertension represent "tip of an iceberg".

Classification of Hypertension:

Guidelines vary from time to time, but generally accepted the classification of hypertension is as follows. An average of two or more properly measured readings at each of two or more visits after an initial screen: (SBP - systolic blood pressure, DBP - diastolic blood pressure and HTN - hypertension)

Normal < 120 mmHg SBP or DBP < 90 mmHg

Prehypertension 120 -139 mmHg SBP or DBP 80 - 89 mmHg

Stage 1 HTN 140 -159 mmHg SBP or DBP 90 - 99 mmHg

Stage 2 HTN >/= 160 mmHg SBP or DBP >/= 100 mmHg

Prevalence of prehypertension among adults in approximately 37 percent with highest among 30 - 39 years of age group, which indicates that awareness is necessary for a regular blood pressure check up.

Why Should Hypertension Be Diagnosed and Treated?

Hypertension currently causes two third of all strokes and half of all cases of ischemic heart disease. Reduction in high blood pressure leads to large reductions in stroke, heart failure, renal failure, aortic dissection, coronary events and death.

Prehypertension:

  • It is an entity where SBP >120 -139 mmHg or DBP 80-89 mmHg.
  • Multiple epidemiological studies demonstrated an increased cardiovascular risk in patients with prehypertension.
  • People with prehypertension have increased risk of progression to sustained hypertension, the prevalence of hypertension increases from approximately 10 percent at age of 30 years to as high as 90 percent after age of 65 years.
  • Framingham hypertension risk prediction score, may help identification of prehypertensive patients who are at greatest risk for progression to hypertension.
  • The risk calculator includes variables like age, sex, family history of hypertension, body mass index and smoking. The most important predictors of these are higher baseline blood pressure and older age.

Screening for Hypertension:

The optimal interval for screening is not known. 2007 USPSTF (United States Preventive Services Task Force) guidelines recommended screening every two years for persons with SBP <120 mmHg and DBP <80 mmHg and yearly for persons with SBP 120-139 mmHg or DBP 80-89 mmHg.

How to Manage Prehypertension?

TROPHY study (Trial Of Preventing Hypertension) results showed that there is no role for pharmacotherapy in prehypertension except in special conditions like diabetes, chronic kidney disease, etc.

As per JNC 7 (the seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure) recommendations patients with prehypertension who do not have diabetes, chronic kidney disease, end organ damage, or clinical evidence of cardiovascular disease are generally treated with non-pharmacological therapies.

Major non-pharmacological therapies that aid to decrease blood pressure are as follows:

1) Weight Reduction:

Maintain normal body weight (BMI 18.5 to 24.9 kg/m2). This can reduce BP by 5 to 20 mmHg per 10 kg weight loss.

2) Adopt DASH Eating Plan:

DASH- Dietary Approach To Stop Hypertension consists of fruits, vegetables, legumes, low fat dairy products with reduced saturated and total fat. This can reduce BP by 8 to 14 mmHg.

3) Dietary Sodium Restriction:

Reduce dietary sodium intake to not more than 100 mEq/day (2.4 g sodium or 6 g of sodium chloride). This can reduce BP by 2 to 8 mmHg.

4) Physical Activity:

Engage in regular aerobic physical activity such as brisk walking for at least 30 minutes per day, four to five days of the week. This can reduce BP by 4 to 9 mmHg.

5) Limit Alcohol Consumption:

Limit consumption of alcohol to not more than two drinks per day in men and not more than one drink in women and lighter weight persons. This can reduce BP by 2 to 4 mmHg.

To know further regarding management of blood pressure consult a high blood pressure specialist online --> https://www.icliniq.com/ask-a-doctor-online/general-medicine-physician/high-blood-pressure

Last reviewed at:
07 Sep 2018  -  3 min read

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