Screening For Prehypertension

Introduction:

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 the "tip of an iceberg." Prehypertension should be taken seriously. It is a step toward getting effects with diseases like high blood pressure or hypertension, which can result in a wide range of health-related problems.

But that does not mean it cannot be reversed. Making key lifestyle changes makes it possible to lower blood pressure to healthy levels and protect the arteries from damage.

Classification of Hypertension:

Guidelines vary from time to time, but the generally accepted 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 (millimetres of mercury) SBP or DBP < 90 mmHg.

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

• Hypertension Stage 1 - 140 -159 mmHg SBP or DBP 90 - 99 mmHg.

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

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

What Can Cause Prehypertension?

Prehypertension can develop for many reasons. This includes:

Lack of physical activity - A sedentary lifestyle can increase the blood pressure in the arteries. Therefore, exercising is recommended to strengthen the heart and help it pump blood more efficiently.

Higher sodium intake - Sodium increases the pressure of blood in the arteries. Examples of high-sodium foods include processed meats, store-bought soups, sauces, and packaged meals.

Smoking- The chemicals in nicotine Trusted Source can constrict blood vessels, which increases blood pressure.

Alcohol intake- An excessive intake of alcohol can also increase blood pressure by constricting (narrowing) the blood vessels.

Lack of sleep- The blood pressure naturally decreases during sleep, so it is very important to have sound sleep. But if a person can not get enough sleep, blood pressure may stay high for a longer time.

Who Is at Higher Risk of Developing Prehypertension?

The following are the risk factors for developing prehypertension.

• Older people over 65 years of age.

• Overweight or obese.

• Black non-Hispanic.

• People suffering from diabetes.

• A family history of hypertension.

Why Should Hypertension Be Diagnosed and Treated?

Hypertension currently causes two-thirds 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 an increased risk of progression to sustained hypertension, the prevalence of hypertension increases from approximately 10 percent at the age of 30 years to as high as 90 percent after the age of 65 years.

Framingham's hypertension risk prediction score may help identify prehypertensive patients at the 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 people 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 The Joint National Committee”s the seventh report on evaluation, detection, treatment, and prevention 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 in decreasing blood pressure are as follows:

1) Weight Reduction:

Maintain normal body weight (BMI 18.5 to 24.9 kg/m2). This can reduce blood pressure 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 blood pressure by 8 to 14 mmHg.

3) Dietary Sodium Restriction:

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

4) Physical Activity:

Involving in regular physical activity such as walking at speed or brisk walking for at least 30 minutes per day, four to five days a 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.

What Are the Complications Associated With Prehypertension?

The following are the complications associated with prehypertension that can not be ignored because some of the conditions can be life-threatening.

• Heart attack.

• Heart failure.

• Stroke.

• Transient ischemic attack.

• Angina (chest pain).

• Kidney disease.

Conclusion:

Hypertension is one of the common problems reported all over the world. Still, people are not aware of it. Prehypertension is a stage between normal blood pressure and developing hypertension. Prehypertension does not need serious treatment, a bit of lifestyle modification, physical activity and healthy eating will help. It is recommended to check blood pressure regularly and get proper treatment to avoid unfortunate circumstances.

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