Prehypertension: It's Not Mild, It's Dangerous

I woke up one day and went in for my physical, as usual. I was surprised and disappointed to learn my blood pressure had crept up. I'm in a medical profession, in a department of anesthesiology, and I'd been trying to live right.

That day, my blood pressure was at 138/86, which doesn't sound bad.

And that's the problem.

Americans do a lot of hand-wringing and worrying about high blood pressure, and many of us know someone on two or even three medications to control blood pressure that's gone into the full-blown hypertension zone, with the systolic reading (top number) of 140 or above.

But the time to worry about blood pressure is when that number tips anywhere between 120 to 139. There's a word for this condition, and it's been around since it was defined by a group of doctors in 2003 -- prehypertension.

Yet most of us, even clinicians, tend to ignore it. Many doctors shrug when their patients have a reading between 120/80 and 140/90. It sounds mild.

Many more people take notice if they are told they have prediabetes, I think, because diabetes goes on to affect about one third of Americans and leads to a range of devastating complications if left unchecked.

The fact is, however, that roughly one-third of Americans, 30 percent, already have prehypertension, including teens and younger children.

For those who think that blood pressure cannot hurt you until it drives over the 140/90 line and becomes full-fledged high blood pressure, think again. Studies have shown that, when the data is crunched, people with prehypertension alone are more at risk of cardiovascular disease, cognitive problems, diabetes and kidney disease. Lowering your slightly elevated blood pressure lowers your potential for a universe of problems.

The good news is that prehypertension is easy to manage. There are lifestyle changes as well as medications (only one is usually needed) that can control prehypertension and keep people out of the danger range.

When I learned my own blood pressure was 138/86, I grew very concerned and asked my doctor what I should do to lower it. He never mentioned taking a drug, and I believe that a drug might have helped.

Diligently I went about working more exercise into my day as a busy anesthesiology researcher. I did more walking, started eating less, and stopped drinking red wine. I put the salt away; I made conscious decisions to avoid salting my food in restaurants; most important of all, I started looking at food labeling.

Here's a big problem: Salt is in just about everything. It's impossible to avoid. Salt is one of the most common compounds in our world, in our diets and in ourselves.

Just this week, the New England Journal of Medicine ran an article stressing that salt consumption should be cut for reasons of heart protection and lower blood pressure . The researchers found that reducing dietary salt by a mere three grams a day would most likely reduce the annual number of new cases of coronary heart disease by 60,000 to 120,000 cases, and reduce the load of stroke cases by 32,000 to 66,000. About 54,000 to 99,000 heart attacks would disappear from the annual count. And from 44,000 to 92,000 people would be spared their death in a year.

Mayor Bloomberg in New York has called for salt awareness, too. On Jan. 11, the city set guidelines recommending maximum amounts of salt for a variety of restaurant and store-bought foods, with the goal of cutting salt levels in food by a quarter overall in five years .

Because prehypertension represents a period in life when we can work with our blood pressure more easily, it may make sense for some people to start a drug to lower their blood pressure before it goes above 140/90. A simple drug like a thiazide diuretic might do the trick.

Economic arguments against taking medicine for prehypertension overlook the relative ease of controlling blood pressure near the normal range, when it's much easier than controlling stage one or two hypertension. These arguments ignore the central issue: patient well-being.

More clinical trials will bear out the effectiveness of drugs for prehypertensive people like me. In the meantime, those with prehypertension face a known, modifiable risk factor for cardiovascular disease, cognitive decline, and kidney disease: a blood pressure greater than 120/80.

I was lucky that I could bring my blood pressure down through diet and exercise changes alone. Maybe a drug would help me, too. And to stay away from hypertension, I would happily take one. Prehypertension isn't a condition to ignore or passively monitor -- it's the first volley from a true enemy of health.