Prehypertension can be defined as the first stage of hypertension. A person is diagnosed with prehypertension if their systolic (top number) reading is between 120 to 139 mmHg, while the diastolic (bottom number) reading is between 80 to 89 mmHg. Prehypertension is considered to be a warning sign that there is a high possibility that you may get high blood pressure in the future.1,2
Having high blood pressure significantly increases your risk of developing a heart attack, coronary heart disease, stroke, kidney failure and heart failure. There is no cure for high blood pressure, but with the right diet, lifestyle changes, and medications, it can be treated and brought under control.
It is important that a person with prehypertension is aware that even as low as 115/75 mmHg, the risk of having a stroke and heart attack doubles for every 20 point increase in your systolic blood pressure. For adults aged between 40 to 70 years, even a 10 point increase in the diastolic blood pressure can increase the risk of having a heart attack and stroke.3
Are You At Risk For Prehypertension?
Almost half of all adults who are older than 18 years tend to have prehypertension or hypertension. These estimates are based on an average of two or more readings taken at two or more visits to the doctor.4 According to the American Heart Association (AHA), approximately 60 million people in the US alone have hypertension.5
People with prehypertension are also at a higher risk for developing other types of cardiovascular disease risk factors, including obesity, high cholesterol, and diabetes. These risk factors are seen more commonly in people with prehypertension as compared to those who have normal blood pressure.
How Can You Tell If You Have Prehypertension?
Prehypertension is similar to hypertension in that both conditions do not really show any signs and symptoms. So how do you know if you have prehypertension? The only way to find out if you have prehypertension is by checking your blood pressure. Apart from the doctor’s clinic, you can also take your blood pressure at home by using a blood pressure monitor. You can also buy a blood pressure machine from the local pharmacy or the grocery store.6
If you are healthy and your top or bottom blood pressure measurements are above normal, you should wait for two to three days and then check it again. If it is still higher than normal, you should let your doctor know so that the appropriate steps can be taken to get it back under control.
Are There Any Symptoms Of Prehypertension?
As stated above, prehypertension usually occurs without any symptoms and is therefore difficult to detect without getting regular blood pressure measurements. In rare cases, extremely high blood pressure can present symptoms like headaches, fatigue, sweating, dizziness, or visual changes. Since these are all generalized symptoms that can occur with many other health conditions, it is important to continue with regular blood pressure checks to detect prehypertension.
What Are The Causes Of Prehypertension?
Researchers do not know for certain what are the exact causes of prehypertension, but it is believed that poor lifestyle choices such as unhealthy eating habits and lack of exercise increase the risk of developing prehypertension. Studies also show that consuming too much salt and alcohol can increase your blood pressure as well.7,8
Do You Get Prehypertension Due To Aging?
Many people wonder if getting high blood pressure is a normal part of aging. However, this is not the case. Many populations around the world have been found to have a minimal increase in their blood pressure as they age. For example, in some parts of the South Pacific, Mexico, and other parts of the world, people tend to have a very low salt intake, and studies have found that in these regions, age-related increase in blood pressure is much smaller as compared to the US.9,10
Can Stress Cause Prehypertension?
The occasional stress or short term stress is not usually the cause of prehypertension, but stress-related increases in blood pressure levels can have an impact over time. Chronic stress can put you at a higher risk of developing prehypertension. Add to this a poor diet, regular alcohol use, and lack of sleep, and prehypertension can become a reality very quickly.
If you know that you are in persistent stress and you are worried about its effect on your blood pressure, then it might be a good idea to introduce some stress-reducing activities like meditation, yoga, listening to music, or anything else that you enjoy doing. Meditation is usually a great idea because it has been found to be beneficial for your blood pressure.11
Can Prehypertension Be Dangerous?
While prehypertension by itself is not dangerous, but it should be taken as a warning sign of the risk of having high blood pressure (hypertension) in the future. This risk increases the likelihood of having a stroke, heart attack, and other types of serious heart-related problems.
If prehypertension is detected and treated early on, it is very much possible to reverse prehypertension.
What is the Treatment for Prehypertension?
At the stage of prehypertension, your doctor is likely to advise you to make certain lifestyle adjustments to help bring your blood pressure down to normal. These include reaching and maintaining a healthy weight, exercising regularly, and ensuring you have a healthy diet that is rich in fresh fruits and vegetables, low-fat dairy, and fatty fish like mackerel, salmon, herring, trout, etc.
The Mediterranean and DASH diets have been shown to reduce blood pressure naturally as they lower your salt intake while adding magnesium, potassium, protein, calcium, and fiber to your meals.
The DASH diet stands for Dietary Approaches to Stop Hypertension and is recommended for those who want to prevent and treat prehypertension. The DASH diet focuses on increasing the intake of fruits, vegetables, lean meats, and whole grains. The diet was designed after research showed that high blood pressure is much less common in people who primarily eat a plant-based diet, including vegetarians and vegans.12,13
This is why the DASH diet is focused more on the intake of fruits and vegetables. You can also have some lean protein sources, including fish, chicken, and beans. At the same time, the diet is low in added sugars, salt, and fat.
Doctors believe that one of the primary reasons why people with prehypertension benefit from the DASH diet is because it restricts your salt intake. The normal DASH diet encourages only one teaspoon or just 2,300 milligrams (mg) of sodium in a day. There is also a low-salt version of the DASH diet that recommends that you have no more than 3/4th teaspoon or 1,500 mg of sodium a day.
The DASH diet has been shown to help lower blood pressure in both healthy people and those with prehypertension. In studies, participants who were on the DASH diet were found to have lower blood pressure even if they did not limit their salt intake or lose weight.14,15
Once the sodium intake was limited, it was found that the diet lowered blood pressure even further, thus showing that it can help people with hypertension as well. The biggest reductions in blood pressure were observed in people who had the lowest consumption of salt.16
In people with high blood pressure, the low-salt DASH diet was found to reduce systolic blood pressure by 112 mmHg, and diastolic blood pressure was lowered by 5 mmHg. In people who had normal blood pressure, the low-salt version of the DASH diet was found to reduce systolic blood pressure by 4 mmHg and diastolic blood pressure by 2 mmHg.15
However, people with prehypertension need to keep in mind that a reduction in blood pressure does not automatically translate to mean a lower risk of heart disease.17
You need to still continue following a healthy lifestyle, healthy well and exercise regularly to reduce your risk of heart disease.
The other diet that is often recommended to people with prehypertension is the Mediterranean diet. This diet is based on traditional foods that people used to eat in Mediterranean countries like Greece and Italy in the 1960s. Researchers have found that people in the Mediterranean region were much healthier than Americans and also had a significantly lower risk of many lifestyle diseases, including hypertension.18
Many studies have shown that the Mediterranean diet can help prevent strokes, heart attacks, type 2 diabetes, and even premature death. It also helps with weight loss. Here are some things you can eat and things to avoid while following the Mediterranean diet for prehypertension.
- Foods you can eat: Fruits, vegetables, nuts, seeds, potatoes, legumes, whole grains, herbs, bread, spices, seafood, fish, and lots of extra virgin olive oil.
- Foods to have in moderation: Eggs, cheese, poultry, and yogurt.
- Foods to have rarely: Red meat
- Foods not to eat: Added sugars, processed meat, sugary beverages, refined grains, refined oils, and highly processed foods.
At the same time, you have to avoid consuming the following unhealthy foods and ingredients:
- Refined grains: Pasta made with refined wheat, white bread, etc.
- Added sugar: Candies, soda, table sugar, ice cream, and others.
- Refined oils: Canola oil, soybean oil, cottonseed oil, etc.
- Trans fats: These are typically found in margarine and many processed foods.
- Processed meat: Hot dogs, processed sausages, etc.
- Highly processed foods: Any food items labeled ‘low fat’ or ‘diet’ or items that appear to have been made in a factory.
When you are following the Mediterranean diet, you should make it a habit to read food labels carefully to make sure you avoid these unhealthy foods and ingredients. There is some controversy over what foods can be a part of the Mediterranean diet. This is primarily because there are many versions of this diet in different countries. While the underlying principle of the diet is that it should be high in healthy plant foods and low in animal foods, but you can also have fish and seafood at least twice in a week.
At the same time, following the Mediterranean diet also involves getting regular physical activity. Here are some healthy, unprocessed foods you can include in your Mediterranean diet:
- Vegetables: Broccoli, kale, tomatoes, onions, spinach, carrots, cauliflowers, cucumbers, and Brussels sprouts.
- Fruits: Bananas, apples, pears, oranges, grapes, strawberries, figs, melons, dates, and peaches.
- Legumes: Peas, beans, pulses, lentils, chickpeas, peanuts, etc.
- Nuts and seeds: Walnuts, almonds, hazelnuts, cashews, macadamia nuts, pumpkin seeds, and sunflower seeds.
- Whole grains: Brown rice, whole oats, barley, rye, corn, whole wheat, whole-grain bread and pasta, and buckwheat.
- Tubers: Sweet potatoes, potatoes, yams, turnips, etc.
- Poultry: Chicken, turkey, duck, etc.
- Fish and seafood: Sardines, salmon, tuna, trout, shrimp, oysters, mackerel, crab, clams, mussels, etc.
- Eggs: Duck, chicken, and quail eggs.
- Dairy: Greek yogurt, yogurt, and cheese.
- Healthy fats: Extra virgin olive oil, avocados, and avocado oil, olives.
- Herbs and spices: Basil, mint, garlic, rosemary, nutmeg, sage, cinnamon, pepper, etc.
Remember to increase your water intake, and you can also have some amount of red wine from time to time.19
Tips for Managing Prehypertension
Apart from changing your diet, here are some tips that can help you manage your prehypertension:
- Lose weight if you are overweight, as being overweight or obese increases the risk of developing hypertension.
- Exercise regularly as not only does exercise help you lose weight, but it also helps you lower blood pressure.
- Eat plenty of fruits, vegetables, fish, whole grains, and low-fat dairy. Following the DASH or Mediterranean diets can help.
- Cut back on your intake of dietary salt or sodium.
- Consume foods that are low in trans and saturated fats and cholesterol.
- Try to follow more of a plant-based or vegetarian diet.
- Drink alcohol in moderation.
Remember that it is essential to get your blood pressure checked regularly. Knowing your blood pressure number can help you manage your prehypertension better. In case you notice any fluctuations in your blood pressure numbers, you should let your doctor know. By following a healthy lifestyle, eating a well-balanced and nutritional diet, and exercising regularly, it is very much possible to manage your prehypertension and even reverse it.
- Elliott, W.J. and Black, H.R., 2007. Prehypertension. Nature Clinical Practice Cardiovascular Medicine, 4(10), pp.538-548.
- Svetkey, L.P., 2005. Management of prehypertension. Hypertension, 45(6), pp.1056-1061.
- Kannel, W.B., Wolf, P.A., Verter, J. and McNamara, P.M., 1996. Epidemiologic assessment of the role of blood pressure in stroke: the Framingham study. Jama, 276(15), pp.1269-1278.
- Guo, X., Zou, L., Zhang, X., Li, J., Zheng, L., Sun, Z., Hu, J., Wong, N.D. and Sun, Y., 2011. Prehypertension: a meta-analysis of the epidemiology, risk factors, and predictors of progression. Texas heart institute journal, 38(6), p.643.
- Circulation. 2021. Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association. [online] Available at: <https://www.ahajournals.org/doi/10.1161/CIR.0000000000000659> [Accessed 31 January 2021].
- Nordmann, A., Frach, B., Walker, T., Martina, B. and Battegay, E., 1999. Reliability of patients measuring blood pressure at home: prospective observational study. Bmj, 319(7218), pp.1172-1172.
- Savica, V., Bellinghieri, G. and Kopple, J.D., 2010. The effect of nutrition on blood pressure. Annual review of nutrition, 30, pp.365-401.
- Muntzel, M. and Drüeke, T., 1992. A comprehensive review of the salt and blood pressure relationship. American journal of hypertension, 5(4S), pp.1S-42S.
- Hollenberg, N.K., Martinez, G., McCullough, M., Meinking, T., Passan, D., Preston, M., Rivera, A., Taplin, D. and Vicaria-Clement, M., 1997. Aging, acculturation, salt intake, and hypertension in the Kuna of Panama. Hypertension, 29(1), pp.171-176.
- Pinto, E., 2007. Blood pressure and ageing. Postgraduate medical journal, 83(976), pp.109-114.
- Anderson, J.W., Liu, C. and Kryscio, R.J., 2008. Blood pressure response to transcendental meditation: a meta-analysis. American journal of hypertension, 21(3), pp.310-316.
- Sacks, F.M., Moore, T.J., Appel, L.J., Obarzanek, E., Cutler, J.A., Vollmer, W.M., Vogt, T.M., Karanja, N., Svetkey, L.P., Lin, P.H. and Bray, G.A., 1999. A dietary approach to prevent hypertension: a review of the Dietary Approaches to Stop Hypertension (DASH) Study. Clinical cardiology, 22(S3), pp.6-10.
- Ha, S.K., 2014. Dietary salt intake and hypertension. Electrolytes & Blood Pressure: E & BP, 12(1), p.7.
- Appel, L.J., Moore, T.J., Obarzanek, E., Vollmer, W.M., Svetkey, L.P., Sacks, F.M., Bray, G.A., Vogt, T.M., Cutler, J.A., Windhauser, M.M. and Lin, P.H., 1997. A clinical trial of the effects of dietary patterns on blood pressure. New England journal of medicine, 336(16), pp.1117-1124.
- Saneei, P., Salehi-Abargouei, A., Esmaillzadeh, A. and Azadbakht, L., 2014. Influence of Dietary Approaches to Stop Hypertension (DASH) diet on blood pressure: a systematic review and meta-analysis on randomized controlled trials. Nutrition, metabolism and cardiovascular diseases, 24(12), pp.1253-1261.
- Sacks, F.M., Svetkey, L.P., Vollmer, W.M., Appel, L.J., Bray, G.A., Harsha, D., Obarzanek, E., Conlin, P.R., Miller, E.R., Simons-Morton, D.G. and Karanja, N., 2001. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. New England journal of medicine, 344(1), pp.3-10.
- Adler, A.J., Taylor, F., Martin, N., Gottlieb, S., Taylor, R.S. and Ebrahim, S., 2014. Reduced dietary salt for the prevention of cardiovascular disease. Cochrane database of systematic reviews, (12).
- Trichopoulou, A. and Lagiou, P., 1997. Healthy traditional Mediterranean diet: an expression of culture, history, and lifestyle. Nutrition reviews, 55(11), pp.383-389.
- Mezzano, D., Leighton, F., Martinez, C., Marshall, G., Cuevas, A., Castillo, O., Panes, O., Munoz, B., Perez, D.D., Mizon, C. and Rozowski, J., 2001. Complementary effects of Mediterranean diet and moderate red wine intake on haemostatic cardiovascular risk factors. European journal of clinical nutrition, 55(6), pp.444-451.