Prehypertension and the cardiometabolic syndrome: pathological and clinical consequences

Abstract

Prehypertension is the category of blood pressure (BP) defined as systolic BP between 120 and 139 mmHg and diastolic BP between 85 and 89 mmHg. Prehypertension is a continuum to hypertension and is emerging as an important risk factor for cardiovascular disease. The definition of the cardiometabolic syndrome is a cluster of several risk factors such as abdominal obesity, prehypertension or hypertension, dyslipidemia and prediabetes. Prevention by lifestyle intervention and also treatment of individual components is recommended, given that most subjects with metabolic syndrome fall into the high-risk category. There are several studies with dietary approaches, which showed that these approaches helped in stopping the progression of hypertension and also improved the metabolic conditions. Several large trials are under way to study several antihypertensive drugs to delay the development of hypertension. Identifying early cardiovascular disease in asymptomatic individuals provides a better guide to the need for individualized preventive therapy than traditional risk factor assessment.

Keywords::

• abdominal obesity
• cardiovascular disease
• dyslipidemia
• metabolic syndrome
• prediabetes
• prehypertension

Financial & competing interests disclosure

D Duprez has received research grants from NIH, Novartis, Sanofi-Aventis and Regeneron. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Prehypertension is defined as a systolic blood pressure of 120–139 mmHg and/or a diastolic blood pressure of 80–89 mmHg and is associated with excessive cardiovascular risk.

• • Prehypertension is associated with endothelial dysfunction, functional and structural vascular abnormalities and sinus tachycardia.

• • Prehypertension is often associated with a cluster of other cardiovascular risk factors such as abdominal obesity, prediabetes and dyslipidemia, which is clinically translated into the cardiometabolic syndrome.

• • Current guidelines recommend non-pharmacological treatment for prehypertension.

• • There is evidence that angiotensin II receptor blockers and angiotensin converting enzyme inhibitors can delay the development of hypertension in prehypertensive subjects.

• • Future studies should focus on elucidating whether these measures may be cost-effective in identifying persons at risk of hypertension and the cardiometabolic syndrome and who may benefit from earlier treatment.