Monday, March 17, 2014

IS PRE-HYPERTENSION AS INNOCENT AS IT SOUNDS?

JNC 7 classified a new category of pre-hypertension, documenting that a BP of systolic 120mmHg and below and a diastolic of 80 mmHg and below as normal. Anything that is systolic 140 mmHg and diastolic of 90mmHg and above as hypertensive. In between this two states, is the zone of  121 - 139 mmHg systolic and 81-89 mmHg diastolic. JNC 7 has classified this as pre-hypertension. Of course JNC 8 ( or JNC fake ) is quiet on this.
Is pre-hypertension a state before hypertension, and so does not carry the risk of hypertension, viz strokes, heart attacks and renal injury resulting in end stage renal disease, or does it?
Well, a group of researches from China looked into this question.
Dr Dingli Wu and colleagues from the Southern University of Guanzhou did a meta-analysis of 19 prospective clinical trials on pre-hypertension to study the CNS risk. This paper was publishes in the March 12th online edition of Neurology. Having reviewed the records of Pub Med and EMBASE on these 19 prospective trials, they found that pre-hypertension was not so innocent.

Table. Risk for Stroke With Prehypertension vs Optimal Blood Pressure
Blood PressureRelative Risk (95% Confidence Interval)
Any prehypertension (120 - 139/80 - 89 mm Hg)1.66 (1.51 - 1.81)
High prehypertension (130 - 139/85 - 89 mm Hg)1.95 (1.73 - 2.21)
Low prehypertension (120 - 129/80 - 84 mm Hg)1.44 (1.27 - 1.63)

All ranges of pre-hypertension carries an increase risk of stroke. The higher the pre-hypertension, the higher the risk of stroke. The bottom line is that we should all endeavor to keep as low a BP as possible as long as it does not cause us to be too tired or too dizzy.
Having said that, looking at this paper, it is a meta-analysis, so it is generally correct, but must be taken with a pinch of salt. Meta-analysis does not look at specific patient subsets to risk adjust and also match. They just lump all together and see the general trend.
So, although we note that even 130/85 is OK, but still carries a small risk, and so is not so OK. 
We should all eat 5 portions of fruits daily, as much greens as we can and also without added salt in diet. A healthy dose of exercise weekly or thrice weekly sure helps. Of course no smoke whether real cigarettes or electronic ones.
Nothing like a healthy lifestyle.

2 comments:

Winston Yap said...

I understand that genes also count where diseases are concerned.
In the case of hypertension, one's age is also very material.
Since the older one gets, the harder the arteries will become.
As it is, the goal posts for health have been moved quite a number of times.
Previously, 130/80 was the level to die for.
Now, it's 120/80!!!
And on top of that, there is also prediabetes to watch out for.
The way our health mentors are going about their work, life may no longer be worth living.
What with so many moving goal posts to watch out for!!!

hmatter said...

Please do not fred. Do not give up.
Live is good and worth living.