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A Simulation

Louise B. Russell, PhD; Elmira Valiyeva, PhD; Jeffrey L. Carson, MD

Arch Intern Med. 2004;164:2119-2124.

Background  The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recently released new clinical practice guidelines that target systolic blood pressure and identify persons with "prehypertension" (systolic blood pressure, 120-139 mm Hg), previously considered normal, as being at elevated risk and in need of intervention.

Methods  We used a simulation model, fitted to longitudinal data from the first NHANES (National Health and Nutrition Examination Survey) Epidemiologic Followup Study, to estimate the effects of prehypertension and residual hypertension (systolic blood pressure, 140 mm Hg). The term residual hypertension recognizes that many people with hypertension have lowered their pressures through treatment, but not to less than 140 mm Hg. We applied the model to a representative sample of US adults aged 25 to 74 years from NHANES III.

Results  Except for women aged 25 to 44 years, more than a third of each age group in NHANES III had prehypertension. Approximately two thirds of persons aged 45 to 64 years and 80% of persons aged 65 to 74 years had prehypertension or residual hypertension. Together, prehypertension and residual hypertension accounted for 4.8% of hospital admissions per 10 000 adults aged 25 to 74 years, 9.9% of nursing home admissions, and 13.0% of deaths. Prehypertension alone accounted for 3.4% of hospitalizations, 6.2% of nursing home stays, and 8.5% of deaths. Numbers of events attributable to prehypertension are greatest for men aged 45 to 64 years and persons aged 65 to 74 years.

Conclusions  Our results confirm the substantial public health consequences of prehypertension. If prehypertension were eliminated, hospitalizations, nursing home admissions, and premature deaths could decline substantially.

Author Affiliations: Institute for Health, Health Care Policy, and Aging Research and Department of Economics, Rutgers University (Drs Russell and Valiyeva), and Division of General Internal Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School (Dr Carson), New Brunswick. Dr Valiyeva is now with the Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ.

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