Don’t take‘pre’-illness too lightly
Q: My doctor says I have prehypertension. If it’s “pre,” then I don’t need to worry about it, right?
A: Prehypertension is a blood pressure reading of 120-139/80-89 mm Hg. That’s the gray zone between normal blood pressure (below 120/80) and hypertension, or high blood pressure (above 140/90). We know that hypertension is dangerous. It increases your risk of heart disease, stroke, kidney disease and impaired vision.
Doctors first coined the term “prehypertension” because they found evidence that having prehypertension puts you at higher than average risk for developing hypertension later on. Having prehypertension meant, at a minimum, two things. First, it was even more important for you than for the average person to make the lifestyle changes that reduced your risk of getting hypertension. Second, it meant your blood pressure needed to be measured more frequently.
Now, new studies reveal that prehypertension also poses health risks of its own. It may independently increase your risk of having a stroke. For example, researchers analyzed 19 high-quality studies that focused on the links between prehypertension and stroke. The researchers broke down the participants into two groups:
■ Low-range prehypertension: blood pressure between 120/80 and 129/84.
■ High-range prehypertension: blood pressure between 130/85 and 139/89.
People with high-range prehypertension had a 95 percent higher stroke risk compared with people with normal blood pressure. Those in the low range had a 44 percent higher stroke risk.
This study only adds to the evidence that we should take prehypertension seriously. How seriously? So far, doctors don’t recommend that people with prehypertension take medications. Blood pressure drugs lower blood pressure, but they can also cause harmful side effects. In the prehypertension range, benefits and risks seem to cancel each other out.
Instead, people with prehypertension should focus on lifestyle changes: low-salt diets, healthy weight and regular exercise.
After the concept of “prehypertension” began to appear in the media, a patient asked me a question. “Why do you doctors keep lowering the threshold of things I should worry about? Are the drug companies pushing you to prescribe more drugs, so they make more money?”
Well, that’s an understandable concern. Unfortunately, some doctor “thought leaders” are paid a lot of money by drug companies, and then talk to other doctors about the virtues of medications.
For the record, I don’t take any money from drug companies. In any event, I’ll recommend medications for something only when I think there’s solid scientific evidence that you will benefit — and that the benefit will exceed the risk.
DR. ANTHONY KOMAROFF is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.askdoctork.com.