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PREHYPERTENSION: WHAT IS THE CURRENT STATUS?

WHAT IS THE WAY FORWARD?

The number of individuals with prehypertension is overwhelming. Evidence for the use of pharmacological agents on outcome in prehypertension is still lacking. It is unlikely that such studies will be done because it would be very costly as large numbers of prehypertensive subjects will need to be studied in randomized controlled trials. As such, currently pharmacological treatment is not the answer nor is it feasible. Besides the lack of evidence, the cost of treatment, the biochemical changes and potential adverse events may outweigh the benefits of treatment of prehypertension.

However while evidence about pharmacological treatment of prehypertension is not available, it should not prevent doctors and the public health from embarking on preventing hypertension. As evidence is available showing that lifestyle modification is effective, practitioners should devote more effort on providing counselling to patients with prehypertension. It is acknowledged that for a host of various reasons, doctors are not very proficient at providing this support. Ways to improve this is to provide more training for the practitioners and other health care professionals and even to reimburse doctors for their time in providing this efficacious management.

Doctors cannot work alone. Public health groups, the school curriculum as well as food provided to children, the media, the food industry and even local authorities (to provide more space for physical activities for example) need to get together to develop a system-wide approach. Besides all these strategies, legislation and polices are likely required to achieve the goals of preventing hypertension and ultimately reducing CVD morbidity and mortality.

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