Is Low-Risk Hypertension Fact or Fiction?Cardiovascular Risk Profile in the TROPHY Study

Abstract

Our data from individuals with high normal BP suggests clearly that the risk of cardiovascular disease begins to rise before the diagnosis of hypertension is evident. The overall risk in such subjects reflects both the rising BP and other concurring factors. It appears that truly low-risk hypertension only rarely exists.

Burden and predictors of hypertension in India: results of SEEK (Screening and Early Evaluation of Kidney Disease) study

“…The authors observed that throughout middle and old age, blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mmHg [47]. The Trial Of Preventing Hypertension (TROPHY) also echoed the same observations that the CVD risk begins to rise even before the diagnosis of HTN is made [48]. The JNC 7 calls for routine blood pressure measurement at least once every 2 years for adults with pre-hypertension [8] and the American Heart Association issued similar recommendations for adults beginning at age 20 years for primary prevention of hypertension [49].…”

Effects of normal blood pressure, prehypertension and hypertension on left ventricular diastolic function and aortic elastic properties

“…The mechanism of excess risk from PHT is presumed to be the same as that from hypertension. It has also been shown that PHT is associated with subclinical atherosclerosis, including increased coronary atherosclerosis (7); however, there is no prior data regarding the impact of PHT on left ventricular (LV) diastolic function and aortic elastic properties which are surrogate markers of hypertensive target-organ damage.…”

The PHARAO study: prevention of hypertension with the angiotensin-converting enzyme inhibitor ramipril in patients with high-normal blood pressure – a prospective, randomized, controlled prevention trial of the German Hypertension League

“…The study was planned and conducted in parallel with the Trial of Preventing Hypertension (TROPHY), which has been recently published, demonstrating a significant reduction in the development of hypertension in prehypertensive patients during antihypertensive treatment [3,4]. As high-normal BP is defined by quite a narrow range of BP values, for appropriate recruitment, it is necessary to detect and separate patients with 'white coat' hypertension, as well as with 'masked' hypertension [normotensive by clinical measurement and hypertensive by ambulatory blood pressure monitoring (ABPM)] from these with true high-normal BP [5].…”