Pre-hypertension as a predictor of hypertension in military aviators: A longitudinal study of 367 men

Background: Recently, the seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure introduced the term "pre-hypertension" for systolic blood pressure (BP) levels of 120-139 and diastolic BP levels of 80-89 mmHg. Our aim was to establish the prevalence of this novel entity among young subjects, and to assess the rate of progression to hypertension. Methods: We retrospectively analyzed the data of a group of 367 male aviators who were examined at the age of 18 and who were followed for an average of 18 ± 7 yr (range 3-37 yr). Systolic and diastolic BP, heart rate, and body mass index (BMI) were measured at the age of 18 and at the end of the follow-up. Results: At the age of 18, 176 subjects (48%) had pre-hypertension. Subjects with pre-hypertension had higher BP levels (132 ± 6/76 ± 8 vs. 115 ± 6/72 ± 7 mmHg; p < 0.001), heart rate (71 ± 12 vs. 65 ± 12 bpm; p < 0.001) and BMI (22.4 ± 2.9 vs. 21.7 ± 2.5 kg·m^-2 p < 0.05) than the subjects with normal BP. During the follow-up period, 110 subjects (30%), 77 with pre-hypertension and 33 with normal BP, developed hypertension. Pre-hypertensive subjects had an odds ratio of 3.7 (95% CI; 2.3-6.2) to develop hypertension as compared with subjects with normal BP. Conclusions: Pre-hypertension is common and it predicts the development of frank hypertension. Thus, subjects with pre-hypertension should be closely followed and encouraged to begin lifestyle modification in order to prevent future complications.