Prehypertension: To Treat or Not To Treat Should No Longer Be the Question Shawn G. Kwatra, Amanda E. Kiely and Madan M. Kwatra Hypertension. 2012;59:e27; originally published online February 27, 2012; doi: 10.1161/HYPERTENSIONAHA.111.190678 Hypertension is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2012 American Heart Association, Inc. All rights reserved. Print ISSN: 0194-911X. Online ISSN: 1524-4563 The online version of this article, along with updated information and services, is located on the World Wide Web at: http://hyper.ahajournals.org/content/59/4/e27 Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Hypertension can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Hypertension is online at: http://hyper.ahajournals.org//subscriptions/ Downloaded from http://hyper.ahajournals.org/ by guest on September 9, 2014 Letter to the Editor Letters to the Editor will be published, if suitable, as space permits. They should not exceed 1000 words (typed double-spaced) in length and may be subject to editing or abridgment. Prehypertension: To Treat or Not To Treat Should No Longer Be the Question To the Editor: We read with great interest the article by Selassie et al1 that progression from prehypertension to full-blown hypertension occurs more rapidly in blacks, with 50% transitioning to hypertension within 1.7 years compared with 2.7 years in whites. Although the authors highlight the importance of controlling prehypertension, we feel that the authors missed an opportunity to stress the feasibility of using antihypertensive drugs to control prehypertension. As we argued previously,2 the recommendation by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure to treat prehypertension only with lifestyle changes3 is unlikely to work. Our view that prehypertension should be treated pharmacologically is supported by a recent meta-analysis of 16 trials involving 70 664 patients.4 This analysis found that prehypertensive patients randomized to the active treatment arm had a 22% reduction in the risk of stroke as compared with the placebo group. In addition, treatment of prehypertension with an angiotensin receptor blocker reduced the risk of incident hypertension.5 Thus, the debate of whether to treat prehypertension should end. Treating prehypertension is medically sound and economically viable,2 and benefits of treatment are now apparent. Disclosures None. Shawn G. Kwatra Wake Forest University School of Medicine Winston-Salem, NC Amanda E. Kiely Department of Ophthalmology The Johns Hopkins University School of Medicine Baltimore, MD Madan M. Kwatra Department of Anesthesiology Duke University Medical Center Durham, NC 1. Selassie A, Wagner CS, Laken ML, Ferguson ML, Ferdinand KC, Egan BM. Progression is accelerated from prehypertension to hypertension in blacks. Hypertension. 2011;58:579–587. 2. Kiely AE, Kwatra SG, Kwatra MM. Treating prehypertension: medically sound and economically viable. Blood Press. 2009;18:300–303. 3. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Paril S, Wright JT Jr, Roccella EJ. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42: 1206–1252. 4. Sipahi I, Swaminathan A, Natesan V, Debanne SM, Simon DI, Fang JC. Effect of antihypertensive therapy on incident stroke in cohorts with prehypertensive blood pressure levels: a meta-analysis of randomized controlled trials. Stroke. 2012;43:432–440. 5. Julius S, Nesbitt SD, Egan BM, Weber MA, Michelson EL, Kaciroti N, Black HR, Grimm RH Jr, Messerli FH, Oparil S, Schork MA. Feasibility of treating prehypertension with an angiotensin-receptor blocker. N Engl J Med. 2006;354:1685–1697. (Hypertension. 2012;59:e27.) © 2012 American Heart Association, Inc. Hypertension is available at http://hyper.ahajournals.org DOI: 10.1161/HYPERTENSIONAHA.111.190678 Downloaded from http://hyper.ahajournals.org/ by guest on September 9, 2014 e27