Risks and prevention of prehypertension

Predhipertenzija je definirana kao arterijski tlak od 120-139/80-89 mmHg. Pojavljuje se u svim dobnim skupinama i zahvaća oko 25–50% odraslih u svijetu. Rizični čimbenici povezani s nastankom predhipertenzije su pretilost, pušenje, prevelik opseg struka, diabetes melitus, dislipidemija, konzumacija alkohola. Predhipertenzija (PHT) povećava rizik od incidentne hipertenzije i incidenciju kardiovaskularnih bolesti (KVB), pogotovo u 2. stupnju (130-139/85-89 mmHg), u kojem je i povećana smrtnost. Za pojedince srednje dobi bez dijabetesa melitusa i KVB rizik iznosi oko 10%, a za one s navedenim komplikacijama i starije je oko 40%. Praćenje pojedinaca s predhipertenzijom pokazalo je da imaju uvećanje atrija i ventrikula, zadebljanje intime karotidnih arterija, povećanu krutost velikih arterija, promjene na krvnim žilama očne pozadine te znakove generalizirane endotelne disfunkcije vidljive kao mikroabuminurija. Nejasno ostaje jesu li te promjene isključivo posljedica ili neke od njih djelomično mogu biti i uzrokom predhipertenzije. Promjenama životnih navika može se postići oko 20% manji rizik za incidentnu hipertenziju, a primjenom antihipertenzivne monoterapijie on se može sniziti za 34–66%. Za sada su pozitivne rezultate u prevenciji dali blokatori angiotenzinskih receptora i ACE–inhibitori. Podatci o uspješnosti u primarnoj prevenciji za sada su nedostatni. Nužno je identificirati pojedince pod povišenim rizikom od komplikacija PHT. Dosadašnja saznanja upućuju kako je potrebno provesti dodatna istraživanja mogućnosti primjene antihipertenzivne terapije u predhipertoničara na velikim populacijama. Edukacija populacije o rizicima predhipertenzije važan je izazov za primarnu zdravstvenu skrb, a potrebno je razviti i učinkovitu javnozdravstvenu strategiju u suočavanju s ovim problemom.Prehypertension is defined as blood pressure between 120-139/80-89 mmHg. It is present in all age groups and affects 25–50% of adults globally. Risk factors associated with prehypertension (PHT) are obesity, higher waist circumference, diabetes mellitus, smoking, dislypidemia, alcohol consummation. It increases the relative risk of incident hypertension as well as incidence of cardiovascular disease, especially in its stage 2 (130-139/85-89 mmHg) which accounts also for increase in mortality. For middle-aged individuals without diabetes mellitus and CVD, risk is 10% while it rises to 40% for those affected with diseases mentioned earlier. Follow up of individuals with prehypertension revealed that they have atrial and ventricular enlargement, increased carotid intima-to-media thickness, increased stiffness of large arteries, changes of retinal blood vessels, as well as signs of global endotelial dysfunction, presented as microalbuminuria. It is however unclear whether some of those changes are solely the consequence or they can be partially the cause of prehypertension. With lifestyle changes it is possible to decrease the risk for incident hypertension by 20%, while antihypertensive monotherapy lowers it by 34–66%. For now, positive results have been obtained with angiotensin receptor blockers and ACE-inhibitors. Data on primary prevention effectiveness are still insufficient. It is important to identify PHT individuals with increased risk for developing CVD disease. Current knowledge on prehypertension shows that it is of utter importance to conduct further large population studies on possibilities to treat prehypertension with antihypertensive therapy. Furthermore, educating population about prehypertension risks is a significant challenge for primary care in the future. It is also necessary to create an effective public health strategy for coping with this problem