Pre-hypertension: another 'pseudodisease’?
1 The Heart Hospital, University College London Hospitals UCLH, 16-18 Westmoreland Street, London W1T 7HA, UK
2 Division of Cardiology, Yale Medical School, New Haven, CT, USA
3 St Luke’s Roosevelt Hospital, Columbia University College of Physicians and Surgeons, New York, NY 10019, USA
4 Bristol Heart Institute, Bristol, UK
BMC Medicine 2013, 11:211 doi:10.1186/1741-7015-11-211Published: 25 September 2013
Hypertension is one of the most important and common cardiovascular risk factors. Defining the level at which blood pressure starts causing end-organ damage is challenging, and is not easily answered. The threshold of blood pressure defining hypertension has progressively been reduced over time, from systolic >160 mmHg to >150 mmHg, then to >140 mmHg; and now even blood pressures above 130 to 120 mmHg are labeled as 'pre-hypertension’ by some expert committees. Are interest groups creating another 'pseudodisease’ or is this trend scientifically justified? A recent meta-analysis published in BMC Medicine by Huang et al. clearly indicates that pre-hypertension (120 to 140/80 to 90 mmHg) is a significant marker of increased cardiovascular risk. This raises the question as to whether we now need to lower the threshold of 'hypertension’ (as opposed to 'pre-hypertension’) to >120/80 mmHg, redefining a significant proportion of currently healthy people as 'patients’ with an established disease. These data need to be interpreted with some caution. It is controversial whether pre-hypertension is an independent risk factor or just a risk marker and even more controversial whether treatment of pre-hypertension will lower cardiovascular risk.