From the Guidelines
Prehypertension should be managed primarily through lifestyle modifications, with medication considered only in the presence of other cardiovascular risk factors or conditions like diabetes, as stated in the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure 1.
Lifestyle Modifications
These modifications include:
- Maintaining a healthy weight or losing weight if overweight
- Adopting the DASH diet (rich in fruits, vegetables, whole grains, and low-fat dairy)
- Reducing sodium intake to less than 2,300 mg per day
- Engaging in regular physical activity (at least 150 minutes of moderate-intensity exercise weekly)
- Limiting alcohol consumption (no more than 2 drinks daily for men and 1 for women)
- Avoiding tobacco use Regular blood pressure monitoring is recommended, with home measurements providing valuable data between clinical visits.
Rationale
The rationale behind these recommendations is based on the understanding that prehypertension is a designation chosen to identify individuals at high risk of developing hypertension, and that lifestyle modifications can effectively reduce this risk without the side effects associated with pharmacological treatment 1. Additionally, the relationship between blood pressure and stroke risk is strong, continuous, graded, consistent, independent, predictive, and etiologically significant, making lifestyle modifications a crucial aspect of prehypertension management 1.
Considerations
It is essential to consider the total cardiovascular risk of each individual when managing prehypertension, as the threshold for hypertension should be considered flexible, being higher or lower based on the total cardiovascular risk of each individual 1. This approach allows for personalized management and reduces the risk of unnecessary medical interventions.
Key Points
- Lifestyle modifications are the primary intervention for prehypertension
- Medication is considered only in the presence of other cardiovascular risk factors or conditions like diabetes
- Regular blood pressure monitoring is essential
- Total cardiovascular risk should be considered when managing prehypertension
- A flexible approach to the threshold for hypertension is necessary, taking into account the individual's total cardiovascular risk 1.
From the Research
Guidelines for Prehypertension
The guidelines for prehypertension involve lifestyle modifications and nonpharmacologic interventions to reduce blood pressure and prevent the development of hypertension.
- Nonpharmacologic interventions such as weight loss, dietary modification, and increased physical activity are recommended for all patients with prehypertension 2.
- A healthy diet and physical activity combination has been shown to have the highest mean reduction in systolic and diastolic blood pressure [-9.88 mmHg and -6.28 mmHg, respectively] 3.
- The Dietary Approach to Stop Hypertension (DASH) diet has been found to be superior to usual care and other nonpharmacologic interventions in lowering systolic and diastolic blood pressure [weighted mean difference, 6.97 mmHg and 3.54 mmHg, respectively] 4.
Lifestyle Modifications
Lifestyle modifications are crucial in managing prehypertension and preventing the development of hypertension.
- A comprehensive lifestyle intervention program (LSIP) for prehypertension includes educational, dietary, and exercise components 5.
- Aerobic exercise, isometric training, low-sodium and high-potassium salt, comprehensive lifestyle modification, breathing-control, and meditation have been found to lower systolic and diastolic blood pressure 4.
- Weight reduction, DASH eating plan, dietary sodium reduction, increased physical activity, and moderation of alcohol consumption can also lower blood pressure [5-20 mmHg, 8-14 mmHg, 2-8 mmHg, 4-9 mmHg, and 2-4 mmHg, respectively] 6.
Recommendations
Based on the available evidence, the following recommendations can be made:
- Patients with prehypertension should be advised to adopt a healthy lifestyle, including a balanced diet and regular physical activity 3, 2.
- The DASH diet should be recommended as a first-line intervention for lowering blood pressure 4.
- A comprehensive LSIP should be developed and implemented to manage prehypertension and prevent the development of hypertension 5.