Slightly Elevated Blood Pressure Increases Risk for Heart Attack

Prehypertension — it sounds like a warning, but in fact this condition, defined as blood pressure higher than 120/80 mmHg but not quite at the “high” level, identified as 140/90 — is officially a diagnosis and one to take seriously. A recent study found that people with prehypertension are at higher risk for heart disease and heart attack. In fact, lead author Adnan I. Qureshi, MD, executive director of the Minnesota Stroke Institute and Zeenat Qureshi Stroke Research Center at the University of Minnesota, says this might well be the culprit in many so-called “inexplicable” heart attacks suffered by seemingly healthy people.

SERIOUS RISKS

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure issued guidelines in 2003 that blood pressure previously considered “high normal” — falling between normal (120/80) to just under the start of high (140/90) — was an official medical condition named prehypertension. Though studies had shown for years that high blood pressure (hypertension) is an important cardiovascular risk, no one was sure how much of a risk prehypertension might be — if any.

Dr. Qureshi’s research reveals there is indeed a dramatic increase in risk. An analysis of data taken over 50 years from the long-term ongoing Framingham Heart Study showed that participants with the condition were three times more likely to have a heart attack and 1.7 times more likely to have heart disease than people with normal blood pressure.

Interestingly, the early data from the Framingham Heart Study didn’t take into account metabolic syndrome since it was only identified in 1988. It is quite possible that the factors associated with this condition, including central obesity, insulin resistance and others, are part of the increased risk and that a number of prehypertensive participants also had these factors early on. Nonetheless, this study makes clear that if you have prehypertension, you need to discuss it with your doctor and get an overall evaluation to determine how serious your risk might be.

The first step in treating prehypertension is recognizing there is a problem, not just a potential one. A healthy lifestyle is key to reducing risk. Quit smoking, exercise 30 minutes a day most days of the week, manage stress, reduce sodium, maintain a normal weight and limit alcohol to two drinks a day for men and one for women. The next line of defense against hypertension is diuretics, although they have potential side effects, including potassium loss from some and increased blood sugar levels and diabetes from thiazide diuretics, in particular. Even so, Dr. Qureshi notes that lifestyle and dietary changes alone may not be sufficient for all prehypertensive people. If you have diabetes or established cardiovascular disease, the benefits of diuretics or other blood-pressure medications may outweigh the risks and be worth considering.