Friday, February 08, 2013


Pre-Hypertension is a disease invented by JNC 7, I think, in an attempt to shift the goal post to earlier diagnosis and earlier implementation of life style modification. Previously, we will diagnose HBP at a BP of 140/90 mmHg. With JNC 7 guidelines, we are told that a BP of >130/ 80 puts one at risk of developing hypertension and so should be counselled on life style modification, in an attempt to ward off HBP. Is this true? Can life style modification in healthy adults ward off hypertension, or is Pre-HBP a pit stop on the way to hypertension, and so should be treated early? Interesting.
This issue was of course, intensively discussed at the just concluded 2013 International Conference on Pre-hypertension and the cardiometabolic syndrome at Barcelona.
At this meeting, two papers on this subject were presented. Dr Flavus Fuch of Port A;egre, Brazil, presented data from the PREVER study. PREVER stands for "Prevention of Hypertension inpatients with Pre-hypertension" study. They enrolled 1,053 patients with pre-hypertension ( 120-139/80-89 mmHg ), gave then counselling and a regime of life-style modification for 3 months. If they are still pre-hypertensive or have become hypertensive after the 3 months, they were randomised into the drug treatment arm of chlorthalidone + amiloride, or to placebo. The follow-up is for 5 years, and the results are not yet know. However, we do know that after 3 months of life style modification, 77% remain either pre-hypertensives or haave become hypertensives ( about 6.2% ). Only 9% have become normotensive. So Dr Fuch is suggesting that we should not waste time. Pre-hypertension should be treated with diuretic. Call it early treatment of hypertension.
The other interesting paper presented was the CHINOM study from China, headed by Dr Yuqing Zhang from Fu Wai Hospital ( where I was before ), Beijing. The study is called the China High Normal Blood Pressure Trial or CHINOM for short. Dr Zhang and colleagues enrolled 10,689 patients with BP < 130-139 / 85-89 mmHg, gave them life style modification and drugs. One arm received Telmisartan 40mg, or Indapamide 1.5 mg or placebo or Combo pill of HCT 12.5 + triamterene 12.5+hydrallazine 12.5 + reserpine 0.1mg. ( what an unusual combination ). They were to be followed for 5 years and the primary endpoint is MACCE. The secondary point is new onset hypertension and diabetes. This means that the Chinese are also keen to treat Pre-hypertension early, to see if there is a difference in MACCE outcomes.
Back home, when I see pre-hypertension ( and there is quite a lot of it. Usually " white coats " ), they get a 60 min counselling including a good understanding of hypertension ( if they can understand and communicate ), self home monitoring ( omron must like me ), and they keep their home BP chart. They are obliged to lose weight, and eat only 2-3 mg of salt. I must say that most of them convert to normo-tensive ( unlike Dr Fuchs in Brazil ), and they just remain on diet, exercise, and regular follow-up with home BP monitoring.
That is my experience.
Would you treat Pre-Hypertension with drugs?


Winston said...

Doc, I think that there is also a serious, if very insidious problem from ingesting hydrogenated fat.
I think that this type of hydrogenated fat is ubiquitous in almost all the foodstuff that we eat, especially those where the fat (oil) must be preserved for a lengthy time by hydrogenating.
This may be especially true of the ever popular 3-in-1 beverages like coffee or tea.
So, are we imbibing too much of such fat?
Aren't we then all heading for serious heart problems from this one source alone?
Can the doctors do something to get the Health Ministry to set the ball rolling in getting vendors of such products to go for substitutes?

hmatter said...

Yes Winston, hydrocarbons are bad. Trans fat are bad. I believe that we should have them banned or severely limited.
I am not so worried about 3:1 coffee, but I am rather upset by the instant noodles. Transfats are very useful for noodle manufacturers, as the transfat is solid at a certain temperature ( room temperature ) and can be liquid when heated.
There is so much poison in instant noodles, I do not know how educated humans can consume those things.

Winston said...

Doc, having said that, I think that positive action should be taken by those in the medical profession to ban such fats altogether, probably through the Health Ministry.
I understand that's what they did in the U.S.
It's a truism that people must be protected against their own detrimental acts!!!