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Prehypertension: the rationale for early drug therapy.

机译：高血压前期：早期药物治疗的理由。

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摘要

Blood pressure within prehypertensive levels confers higher cardiovascular risk by two means. At first, these levels are associated with higher risk for cardiovascular events, starting at BP values as low as 115/75 mmHg, and doubling at each 20 mmHg for systolic or 10 mmHg for diastolic BP. Prehypertension is also an intermediate stage for full hypertension, which develops in an annual rate of 7 out 100 individuals with 40-50 years of age. The precocious drug intervention in patients with prehypertension is therefore appealing. In individuals with previous cardiovascular disease or diabetes the use of BP-lowering agents is compulsory, since the 18-42% reduction of major cardiovascular events demonstrated in randomized clinical trials translates in palpable clinical benefit. In the absence of higher baseline risk, the absolute benefit of treatment is presumably small and was not demonstrated to date. These individuals could be candidate to treatment with the aim to prevent the development of full hypertension. The long-lasting effectiveness of non-drug therapies is low outside the controlled conditions of randomized clinical trials, and there are evidences that the use of BP-lowering drugs reduces the incidence of hypertension in individuals with prehypertension by more than 60%. Clinical trials testing the efficacy and safety of BP agents to prevent hypertension in a population-based perspective are required. In the meantime, it is worthy to present the option to start low doses of BP agents for individuals with prehypertension without co-morbidities who do not respond to the prescription of lifestyle modification.
机译：高血压前的血压可以通过两种方式提高心血管疾病的风险。首先，这些水平与心血管事件的较高风险相关，从低至115/75 mmHg的BP值开始，收缩压每20 mmHg或舒张压BP 10 mmHg翻倍。高血压前期也是完全高血压的中间阶段，每年以100名40-50岁的个体中的7名发展。因此，对高血压前期患者的早熟药物干预很有吸引力。在先前患有心血管疾病或糖尿病的个体中，必须使用降低血压的药物，因为随机临床试验中证明的重大心血管事件减少18-42％可带来明显的临床益处。在没有更高基线风险的情况下，治疗的绝对获益可能很小，并且迄今为止尚未证实。这些人可能是候选者，目的是预防完全高血压。在随机临床试验的控制条件之外，非药物疗法的长期效果很低，并且有证据表明，降低血压的药物的使用可使高血压前期个体的高血压发生率降低60％以上。需要从人群角度测试BP药物预防高血压的功效和安全性的临床试验。同时，值得为高血压前期无合并症且对生活方式改变的处方没有反应的患者提供开始低剂量BP药物的选择。

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