Management of the Patient With Borderline Hypertension

Abstract

A clinical definition of borderline hypertension is offered that includes increased risk of complications but no proof that interventions will be effective in reducing those complications. Defining an average blood pressure level permits improved prediction of individual risk. Simple clinical assessment permits definition of overall risk for hypertension and atherosclerosis. The vigor of intervention should be matched to the level of overall absolute risk. Pharmacologic treatment is appropriate for patients with borderline pressure elevation who have hypertensive target organ changes or a history of hypertensive complications. Patients with borderline hypertension deemed to be at intermediate to high risk but without target organ injury should receive nonpharmacologic (NP) instruction to reduce overall cardiovascular risk. The average blood pressure level, other atherosclerosis risk factors, and the effects of NP measures on these variables should be reevaluated at 6-12-month intervals in this group. Those at low risk should be cautioned about excessive weight gain and should have annual blood pressure measurements.