Prehypertension: Definitions, Clinical Significance and Therapeutic Approaches—To Treat or not to Treat?

Because of its large prevalence and association with higher cardiovascular (CV) risk, prehypertension negatively affects public health. Prehypertension starts as a minor blood pressure (BP) elevation in childhood and young adulthood. Thereafter, BP in the prehypertension group increases steeply. This BP acceleration is associated with the restructuring of resistance arteries. In rats with spontaneous hypertension (SHR) and in humans, lowering BP with drugs that act on the renin–angiotensin system reverses arteriolar changes. In SHR, a short period of early treatment prevented subsequent accelerated hypertension. We investigated whether in prehypertension a period of treatment may postpone the development of hypertension. Two years after discontinuation of treatment, there was a modest suppression of new hypertension. Guidelines suggest lifestyle modifications for the management of prehypertension, but treatment can be initiated in patients with additional CV risk factors.