Pharmacologic treatment for prehypertension: to treat or not to treat?

The Seventh Joint National Committee on the Prevention, Detection, Evaluation and Treatment of Hypertension (VII JNC) introduced the term "prehypertension" to designate individuals whose systolic blood pressure (BP) levels are in the range of 120 to 139 mm Hg and diastolic BP between 80 and 89 mm Hg. The decision to establish this new BP category was based on a rate of progression to hypertension, its prevalence and association with other cardiovascular disease (CVD) risk factors, its relationship to the development of CVD, and its therapy. So, the prehypertension term was established to focus attention on a segment of the population who is at higher-than-normal CVD risk and in whom therapeutic approaches to prevent or delay the onset of hypertension would be of value. The VII JNC report has recommended the adoption of healthy lifestyles to achieve BP goals except in prehypertensive subjects with diabetes or chronic renal disease in whom drug treatment is also advocated. The treatment with antihypertensive drugs to prehypertension has been the subject of recent debate. The decision to use antihypertensive drug treatment should be based on global CVD risk rather than on specific levels of BP alone. This review article discusses the background, risk factors, treatment options and some recent patents related to hypertension.