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Kurt J. Greenlund, PhD; Janet B. Croft, PhD; George A. Mensah, MD

Arch Intern Med. 2004;164:2113-2118.

Background  Recent guidelines classify persons with above-optimal blood pressure (BP) but not clinical hypertension as having prehypertension.

Methods  Data were analyzed for 3488 persons aged 20 years and older with BP measured in the 1999-2000 National Health and Nutrition Examination Survey. The prevalence of risk factors—above-normal (200 mg/dL [5.17 mmol/L]) and high (240 mg/dL [6.21 mmol/L]) total cholesterol levels, diabetes mellitus, current smoker, and overweight or obesity—and the number of risk factors present were compared among BP groups (normotension, prehypertension, and hypertension). Multivariable logistic regression included age, sex, and race/ethnicity as covariates.

Results  Overall, 39% of persons were normotensive,31% were prehypertensive, and 29% were hypertensive. The age-adjusted prevalence of prehypertension was greater in men (39.0%) than in women (23.1%).African Americans aged 20 to 39 years had a higher prevalence of prehypertension (37.4%) than whites (32.2%) and Mexican Americans (30.9%), but their prevalence was lower at older ages because of a higher prevalence of hypertension. The probabilities of above-normal cholesterol levels, overweight/obesity, and diabetes mellitus were greater for persons with prehypertension vs normotension, whereas the probability of currently smoking was lower. Persons with prehypertension were 1.65 times more likely to have at least 1 other adverse risk factor than were those with normotension (P<.001). Among participants with prehypertension, there were no significant race/ethnic or sex differences in the likelihood of having at least 1 other risk factor.

Conclusions  The greater prevalence of risk factors in persons with prehypertension vs normotension suggests the continued need for early clinical detection and intervention of prehypertension and comprehensive preventive and public health efforts.

Author Affiliations: Cardiovascular Health Branch, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga.

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