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Randomized Controlled Trial
. 2006 Apr 20;354(16):1685-97.
doi: 10.1056/NEJMoa060838. Epub 2006 Mar 14.

Feasibility of treating prehypertension with an angiotensin-receptor blocker

Stevo Julius  1 , Shawna D Nesbitt, Brent M Egan, Michael A Weber, Eric L Michelson, Niko Kaciroti, Henry R Black, Richard H Grimm Jr, Franz H Messerli, Suzanne Oparil, M Anthony Schork; Trial of Preventing Hypertension (TROPHY) Study Investigators
Affiliations
Free article
Randomized Controlled Trial

Feasibility of treating prehypertension with an angiotensin-receptor blocker

Stevo Julius et al. N Engl J Med. .
Free article

Abstract

Background: Prehypertension is considered a precursor of stage 1 hypertension and a predictor of excessive cardiovascular risk. We investigated whether pharmacologic treatment of prehypertension prevents or postpones stage 1 hypertension.

Methods: Participants with repeated measurements of systolic pressure of 130 to 139 mm Hg and diastolic pressure of 89 mm Hg or lower, or systolic pressure of 139 mm Hg or lower and diastolic pressure of 85 to 89 mm Hg, were randomly assigned to receive two years of candesartan (Atacand, AstraZeneca) or placebo, followed by two years of placebo for all. When a participant reached the study end point of stage 1 hypertension, treatment with antihypertensive agents was initiated. Both the candesartan group and the placebo group were instructed to make changes in lifestyle to reduce blood pressure throughout the trial.

Results: A total of 409 participants were randomly assigned to candesartan, and 400 to placebo. Data on 772 participants (391 in the candesartan group and 381 in the placebo group; mean age, 48.5 years; 59.6 percent men) were available for analysis. During the first two years, hypertension developed in 154 participants in the placebo group and 53 of those in the candesartan group (relative risk reduction, 66.3 percent; P<0.001). After four years, hypertension had developed in 240 participants in the placebo group and 208 of those in the candesartan group (relative risk reduction, 15.6 percent; P<0.007). Serious adverse events occurred in 3.5 percent of the participants assigned to candesartan and 5.9 percent of those receiving placebo.

Conclusions: Over a period of four years, stage 1 hypertension developed in nearly two thirds of patients with untreated prehypertension (the placebo group). Treatment of prehypertension with candesartan appeared to be well tolerated and reduced the risk of incident hypertension during the study period. Thus, treatment of prehypertension appears to be feasible. (ClinicalTrials.gov number, NCT00227318.).

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Comment in

  • Pharmacotherapy for prehypertension--mission accomplished?
    Schunkert H. Schunkert H. N Engl J Med. 2006 Apr 20;354(16):1742-4. doi: 10.1056/NEJMe068057. Epub 2006 Mar 14. N Engl J Med. 2006. PMID: 16537661 No abstract available.
  • Treating prehypertension.
    Grassi DG. Grassi DG. N Engl J Med. 2006 Jul 27;355(4):416; author reply 417-8. doi: 10.1056/NEJMc061382. N Engl J Med. 2006. PMID: 16870923 No abstract available.
  • Treating prehypertension.
    Conen D, Martina B. Conen D, et al. N Engl J Med. 2006 Jul 27;355(4):417; author reply 417-8. N Engl J Med. 2006. PMID: 16871687 No abstract available.
  • Treating prehypertension.
    Baumann M, van den Born BJ. Baumann M, et al. N Engl J Med. 2006 Jul 27;355(4):416-8; author reply. N Engl J Med. 2006. PMID: 16874901 No abstract available.
  • Treating prehypertension.
    Lopez-Plasencia Y, Amela-Peris R, Garcia-Delgado Y. Lopez-Plasencia Y, et al. N Engl J Med. 2006 Jul 27;355(4):416-7; author reply 417-8. N Engl J Med. 2006. PMID: 16874902 No abstract available.
  • CHARISMA and TROPHY.
    Liebson PR. Liebson PR. Prev Cardiol. 2006 Fall;9(4):235-8. doi: 10.1111/j.1520-037x.2006.04994.x. Prev Cardiol. 2006. PMID: 17085987 No abstract available.
  • How "pre" is prehypertension?
    Materson BJ. Materson BJ. Curr Hypertens Rep. 2007 Jun;9(3):173-4. doi: 10.1007/s11906-007-0031-5. Curr Hypertens Rep. 2007. PMID: 17519120 No abstract available.
  • TROPHY for preventing hypertension.
    Siragy HM. Siragy HM. Curr Hypertens Rep. 2007 Aug;9(4):259-60. doi: 10.1007/s11906-007-0047-x. Curr Hypertens Rep. 2007. PMID: 17686373 No abstract available.

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