A patient with high normal blood pressure--should we treat?

Currently blood pressure (BP) is considered normal (for most subjects) if below 140 mmHg for systolic and 90 mmHg for diastolic BP. However, the risk of death displays an approximately linear relationship with BP levels below this cut‐off. Therefore more attention is now being paid to the portion of the population characterized by BP levels remaining within normal limits but approaching the 140/90 mmHg level. The 2003 ESH–ESC guidelines define BP between 130/85 and 139/89 mmHg as “high normal”, while the 2003 JNC7 guidelines introduced a new category of “prehypertension” (BP between 120/80 and 139/89 mmHg). Both these conditions affect a significant portion of a general population. Evidence is available that high normal BP is associated with an adverse risk profile and an increased risk of cardiovascular events. Therefore lifestyle changes are recommended in subjects belonging to this category and some trial data indicate that pharmacological treatment may be beneficial in high‐risk subjects with high normal BP levels. Strong evidence on the benefits of therapeutic intervention in this group is, however, still lacking.