Borderline hypertension.

Abstract

Blood pressures over 130 mm Hg systolic and 80 mm Hg diastolic are associated with a significantly increased risk of cardiovascular morbidity and mortality as well as an increased risk of progression to later established hypertension. An average blood pressure based on repeated determinations is a better predictor of target organ damage in hypertensive individuals than an isolated casual clinic blood pressure. Careful clinical assessment of the patient with borderline hypertension can identify those at highest risk for progression to established hypertension and those at greatest risk for cardiovascular morbidity and mortality. We cannot currently recommend pharmacologic therapy for the vast majority of patients with blood pressures between l30/80 and l140/90 mm Hg. Although nonpharmacologic therapy is frequently met with a high degree of noncompliance, there is evidence that modest reductions in salt intake and weight often result in significant reductions in blood pressure. Many patients with borderline hypertension, when appraised of these facts, will comply and attempt to reach these limited goals. Repeated self-determination of blood pressures at home is ideally suited to many patients with borderline hypertension in defining current average blood pressure, detecting future progression, and evaluating the effects of nonpharmacologic interventions.