Effects of prehypertension on admissions and deaths: a simulation.

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, > or =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 4.7% of hospital admissions per 10 000 adults aged 25 to 74 years, 9.7% of nursing home admissions, and 13.7% of deaths. Prehypertension alone accounted for 3.4% of hospitalizations, 6.5% of nursing home stays, and 9.1% 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.