High blood pressure: definitions, prognostic, and therapeutic implications.

Although it is well established that high blood pressure (BP) levels of 140/90 mmHg or higher are associated with increased cardiovascular morbidity and mortality it has not been as well appreciated that lower BP levels, namely those considered to be in the "normotensive" range, also confer an increased risk of cardiovascular disease. Recent data from the Framingham Heart Study have demonstrated that high normal levels (i.e. SBP = 130-139 and/or DBP = 85-89 mmHg) frequently progress to hypertension, are associated with structural and functional cardiovascular alterations, an atherogenic metabolic profile and/or a comorbid condition, and an increased risk of cardiovascular outcomes. Factors that predispose to progression to hypertension include higher SBP and body weight at baseline and weight gain. In low risk subjects with high normal BP, nonpharmacologic measures, especially salt restriction and weight reduction are often adequate to lower BP to < or = 130/80. In those with a high cardiovascular risk profile, BP should be reduced to < or = 120/80 with nonpharmacologic measures and pharmacotherapy.