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Prehypertension and borderline hypertension

INTRODUCTION

Long-term follow-up of patients destined to develop essential (primary) hypertension demonstrates that blood pressure (BP) readings gradually increase over time. They may initially be normal, then prehypertensive (or high-normal), and then intermittently elevated; however, the readings may show considerable variability or lability [1]. The term "labile" hypertension should not be used, but "borderline" hypertension may be appropriate for those patients with some values below 140/90 mmHg.

DEFINITIONS

The seventh report of the Joint National Committee (JNC 7) proposed a new definition of BP values below 140/90 from that of JNC 6 [2]. Based upon the average of two or more readings at each of two or more visits after an initial screen, the following classification was proposed in JNC 7 [1]:

  • Normal blood pressure — systolic <120 mmHg AND diastolic <80 mmHg
  • Prehypertension — systolic 120 to 139 mmHg OR diastolic 80 to 89 mmHg

Since many studies used the definitions from JNC 6, it is useful to compare the differences. The normal category was called optimal blood pressure in JNC 6 and the prehypertension category combines the normal and high-normal categories in JNC 6 [3]. Thus, in JNC 6, the following categories were defined:

  • Optimal blood pressure — systolic <120 mmHg and diastolic <80 mmHg
  • Normal blood pressure — systolic 120 to 129 mmHg and diastolic 80 to 84 mmHg
  • High-normal blood pressure — systolic 130 to 139 mmHg or diastolic 85 to 89 mmHg
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