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Who benefits from treating prehypertension?

BMJ 2010; 341 doi: (Published 24 August 2010) Cite this as: BMJ 2010;341:c4442
  1. Ray Moynihan, conjoint lecturer
  1. 1University of Newcastle, Newcastle, Australia
  1. ray.moynihan{at}

    With a drug company funded conference on prehypertension set to take place next year, Ray Moynihan examines the emergence of this controversial new classification

    When health authorities in the United States were developing new guidelines for the treatment of hypertension in 2003, they decided to create a new diagnostic category. The new category would not be used to diagnose sick people; rather it would label those people whose blood pressure was towards the upper reaches of normal. The problem was what to call this new entity: should it be borderline blood pressure, high normal, or perhaps prehypertension? That’s when market research came to the rescue. “We did focus groups to solidify which one would resonate most with the public,” says George Bakris, professor of medicine at the University of Chicago and a member of the committee that described the new entity. “Prehypertension was a clear winner so we went with that.”

    The 2003 guidelines made clear that prehypertension was “not a disease category.”1 Rather it was a new classification for people with normal systolic blood pressure levels of 120-139 mm Hg or diastolic blood pressure of 80-89 mm Hg. The justification for creating it was simple. The higher the blood pressure, said the guideline writers, “the greater is the chance of heart attack, heart failure, stroke, and kidney disease,” while the risk of death and disease “increases progressively and linearly” from within the normal range. They were also clear that people labelled prehypertensive should not be treated with drugs but urged to adopt lifestyle changes to reduce their risks.

    Global goldmine or useful classification?

    Yet in the wake of the classification—and estimates that up to one in three adults has prehypertension (more than 50 million people in the United States alone)—the new entity is looming large as a possible goldmine for the drug industry. …

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