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Pre-Hypertension Treatment

There is important new research out tonight that may be the start of a different approach in medicine: to treat high blood pressure before it even gets high. The fact is about 69 percent of people who have a first heart attack, 77 percent of those who have a first stroke, and 74 percent of patients with heart failure have blood pressure higher than 140/90 mm hg. So why not catch blood pressure early, before it does its damage?

That’s exactly what researchers set out to show: that treating blood pressure before it becomes definitively high can stop it from becoming what’s considered truly high blood pressure. It’s been called a lot of things by a lot of different people: Transient hypertension, borderline hypertension, high normal blood pressure. Lately it’s called pre-hypertension.

But whatever you call it, it’s that range of blood pressure just under what is clearly abnormal, but isn’t normal itself. It’s a prelude to bad things to come blood pressure wise, and all the complications that come with it--including heart attacks, strokes, and other vascular disease. While normal blood pressure is defined as below 130/85, and true high blood pressure is defined as 140/90, .it’s what’s between these numbers that gets classified as pre-hypertension. It’s not typically treated with medicine; usually diet and exercise are the recommendations, with the goal of weight loss and salt restriction.

But clearly, at some point, blood pressure does goes higher into the true hypertension range. So, what if we were to not wait till then? What if we treated pre-hypertension itself? That’s exactly what researchers did and published their findings in the New England Journal of Medicine and presented the data at the American College of Cardiology conference. They found, using this drug, Atacand, the development of true high blood pressure--140/90 or greater--can be prevented, and in fact, in huge numbers.

In the study, after two years, compared to those not treated with medicine, those on the blood pressure drug were 66 percent less likely to develop true high blood pressure. 40 percent of the participants who received only placebo had developed hypertension, compared with 13.6 percent of the participants who had received Atacand for those two years. While medication isn’t for everyone with pre-hypertension, it might be a sign to treat selected patients.

The drug was stopped after two years, and there was still a 16 percent reduction in risk of developing high blood pressure two years after that. Dr. Franz Messerli, study author out of St. Luke’s Roosevelt Hospital Center, says, “If you do have pre-hypertension and have concomitant risk factors such as high cholesterol such as smoking such as being male African American, you may want actually to look at the possibility of treating pre-hypertension.”

Alton Wolff is a good example. “My father died of congestive heart failure my mother has a heart problem my sister has a heart problem so I’m like next in line. It’s better to control before it gets worse so it doesn’t accelerate,” says Alton.And controlling that pre-hypertension may slow the process of artery destruction, and maybe hold the key to preventing two of the top three killers in the forms of heart disease and stroke.

 “When you look at the fact that 50 million people in the United States alone have pre-hypertension, I think this is going to be a very, very hot topic in the future.” The researchers suspect the drug treatment interrupted blood-vessel processes that raise blood pressure,” says Dr. Messerli. The authors say, though, the findings need to be confirmed in future studies before this becomes an accepted approach.

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