Published online Aug 26, 2014. doi: 10.4330/wjc.v6.i8.728
Revised: June 8, 2014
Accepted: June 14, 2014
Published online: August 26, 2014
Prehypertension (PHTN) is a global major health risk that subjects individuals to double the risk of cardiovascular disease (CVD) independent of progression to overt hypertension. Its prevalence rate varies considerably from country to country ranging between 21.9% and 52%. Many hypotheses are proposed to explain the underlying pathophysiology of PHTN. The most notable of these implicate the renin-angiotensin system (RAS) and vascular endothelium. However, other processes that involve reactive oxygen species, the inflammatory cytokines, prostglandins and C-reactive protein as well as the autonomic and central nervous systems are also suggested. Drugs affecting RAS have been shown to produce beneficial effects in prehypertensives though such was not unequivocal. On the other hand, drugs such as β-adrenoceptor blocking agents were not shown to be useful. Leading clinical guidelines suggest using dietary and lifestyle modifications as a first line interventional strategy to curb the progress of PHTN; however, other clinically respected views call for using drugs. This review provides an overview of the potential pathophysiological processes associated with PHTN, abridges current intervention strategies and suggests investigating the value of using the “Polypill” in prehypertensive subjects to ascertain its potential in delaying (or preventing) CVD associated with raised blood pressure in the presence of other risk factors.
Core tip: There is a current debate over the ideal means of intervening in prehypertension. Since it is the cardiovascular risk that constitute the basis for intervention in both prehypertension and hypertension, the review discusses the following points, that: (1) categorizing blood pressure levels is based on mere 20 mmHg brackets; hence this doctrine may be re-visited to include other cardiovascular risk factors to categorize patients regardless of their blood pressure level; (2) investigating the therapeutic potential of intervening in all pathophysiological processes associated with prehypertension; and (3) ascertaining the therapeutic value of the “Polypill” in prehypertensives as means of primary prevention.