The term ‘pre-disease’ can be confusing. Am I sick or not? Do I need medication or not? Why bother with a ‘diagnosis,’ if I don’t have a disease? To answer this, let’s talk about what pre-hypertension means, and how it affects your health now and in the future.
Hypertension is a disease caused by continuous, high-pressure on the walls of arteries and blood vessels. Over time, this pressure begins to weaken blood vessel walls and damage organs. It can also cause blood clots to develop, leading to a heart attack or stroke.
Hypertension has few symptoms. Most people feel completely normal until a devastating stroke occurs. As a result, doctors aim to diagnose and monitor hypertension early. Blood pressure is measured with a BP cuff. A reading of 120/80 mmHg or lower is normal. Hypertension is diagnosed when a person’s average blood pressure is above 140/90 mmHg.
However, your doctor has told you that your average blood pressure is above 120/80 mmHg and below 140/90 mmHg. It means that you have pre-hypertension. Where does that leave you?
Mind the Gap
First off, you aren’t alone. Over 59 million American adults have prehypertension. To make things more complicated, risks vary based on genetic background. For example, a Caucasian (‘white’) person with hypertension is three times more likely to develop coronary heart disease (CHD) than an Asian person with hypertension. (Source: https://www.nature.com/nrcardio/journal/v12/n7/pdf/nrcardio.2015.17-c1.pdf)
So why have doctors made this distinction at all? The answer is based on research into treatment efficacy and risk. These are studies where scientists determine whether the positive effects of medications outweigh the negatives, which include dangerous side effects. On average, studies found that people with hypertension greatly benefit from treatments that lower their blood pressure. It can save lives and organs. In comparison, prehypertension treatment does not significantly lower the chance of developing an organ disease. The risks outweigh the benefits of the medication.
However, it is important to diagnosis prehypertension because it is an early warning sign that hypertension is on the way.
How do I know my risk?
It’s important to accurately measure your blood pressure. A phenomenon called ‘white coat syndrome’ affects one in five people. Going to the doctor is stressful for many people. Stress temporarily raises blood pressure. As a result, these people have a high BP anytime they are in a clinical setting.
If this is you, your doctor may ask you to take readings at home. It also helps to take 4 to 5 readings throughout the day, to get an accurate idea of your average blood pressure. Your blood pressure is usually highest during the day, and lowest while you are sleeping.
I know my blood pressure. Now what?
The word ‘pre-disease’ means there is still have time for prevention. Remember, too much medication can cause more harm than benefit. But lifestyle changes to diet and exercise can strengthen the heart and arteries with little or no risk.
So if your doctor tries to prescribe you medication for prehypertension, ask more questions. What are their concerns? Is there something about you (age, race, gender) that concerns them more than the average person? If not, ask what lifestyle changes you can make before starting on a medication. Or get a second opinion from another doctor.
Remember, doctors are humans. Sometimes, a good or bad outcome with one patient can influence their decision for another. That is why medical experts created the national guidelines for hypertension. So that doctors AND patients have a starting point to make informed health decisions, together.