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High-Normal Blood Pressure and Cardiovascular Disease

1 in 3 US adults aged 40-59 years has high blood pressure (hypertension); among those over 60 years of age the prevalence is over two-thirds, 67%.[1] High blood pressure is a well known risk factor for cardiovascular disease; the leading cause of death worldwide.[1, 2] As two-thirds of sudden cardiac deaths occur in clinically healthy individuals [2], novel indicators of early recognition of adverse cardiometabolic risk in disease-free adults are clearly needed. It has been demonstrated that healthy disease-free adults with high-normal blood pressure (aka pre-hypertension, defined as 120-139/80-89 mmHg) have an adverse cardiometabolic risk profile.[2]

The prevalence of high-normal blood pressure in disease-free US adults is 36.3%; it is especially common in people with overweight/obesity, enlarged waist lines, and elevated glucose, insulin, hemoglobin A1c (glycated glucose), C-reactive protein (an inflammatory marker), and triglycerides (blood fats).[2]

High-normal blood pressure is an independent risk factor for cardiovascular disease (CVD)...[3-5]

In one study, high-normal blood pressure (systolic pressure of 130-139/ mmHg, diastolic pressure of 85 to 89 mm Hg, or both) at baseline among US adults ages 34-64 years was associated with a hazard ratio for cardiovascular disease of 2.5 in women and 1.6 in men during a 10 year follow-up, compared with those having optimal blood pressure (below and up to 120/80 mmHg).[3] Thus, women and men with high-normal blood pressure had a 2.5 and 1.6 times greater incidence of cardiovascular disease, respectively. Another study found that high-normal blood pressure (120-139/80 -89 mmHg) was associated with a 3.5 fold increased risk of heart attack and a 1.7 fold increased risk of coronary artery disease.[5]

A large meta-analysis of 12 prospective cohort studies (including over 500,000 participants) found high-normal blood pressure to be associated with incident stroke, with an up to 80% increased risk compared to optimal blood pressure.[6] The risk was particularly noted in middle age people[6]

The most recent meta-analysis pooled data from 18 prospective cohort studies including almost 470,000 participants, and also determined the population-attributable risk (PAR) for high-normal blood pressure, ie. the proportion of disease that is attributable to high-normal blood pressure and could be prevented if high-normal blood pressure was eliminated.[7] It was found that high-normal blood pressure elevated the risks of stroke by 71%. In subgroup analyses that took into consideration other cardiovascular risk factors, even for low-range high-normal blood pressure (120-129/80-84 mmHg), the risk of cardiovascular disease was significantly higher by 46% as compared with optimal blood pressure (below and up to 120/80 mmHg), and further increased to 80% with high-range high-normal blood pressure (130-139/85-89 mmHg).


Detection of high-normal blood pressure can be an early marker of adverse cardiometabolic risk profile.[2] High-normal blood pressure (120-129/80-84 mmHg), significantly elevates the risk of cardiovascular disease even after adjusting for multiple cardiovascular risk factors.[7]

Elevated blood pressure in the normal range is highly prevalent. Because the progression of high-normal blood pressure to high blood pressure and its complications can be delayed or prevented by lifestyle changes like healthy food habits and regular exercise [8], it is critical that doctors screen their patients for it. And it is equally important that patients be aware of the health risks conferred by a high-normal blood pressure and make necessary lifestyle changes before it progresses to irreversible health complications.


  1. Go, A.S., et al., Heart disease and stroke statistics--2014 update: a report from the american heart association. Circulation, 2014. 129(3): p. e28-e292.
  2. Gupta, A.K., et al., Prehypertension in disease-free adults: a marker for an adverse cardiometabolic risk profile. Hypertens Res, 2010. 33(9): p. 905-10.
  3. Vasan, R.S., et al., Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med, 2001. 345(18): p. 1291-7.
  4. Liszka, H.A., et al., Prehypertension and cardiovascular morbidity. Ann Fam Med, 2005. 3(4): p. 294-9.
  5. Qureshi, A.I., et al., Is prehypertension a risk factor for cardiovascular diseases? Stroke, 2005. 36(9): p. 1859-63.
  6. Lee, M., et al., Presence of baseline prehypertension and risk of incident stroke: a meta-analysis. Neurology, 2011. 77(14): p. 1330-7.
  7. Huang, Y., et al., Prehypertension and incidence of cardiovascular disease: a meta-analysis. BMC Med, 2013. 11: p. 177.
  8. Suri, M.F. and A.I. Qureshi, Prehypertension as a risk factor for cardiovascular diseases. J Cardiovasc Nurs, 2006. 21(6): p. 478-82; quiz 483-4.
Last modified on Thursday, 05 February 2015 00:12

Medical Writer & Nutritionist

MSc Nutrition

University of Stockholm & Karolinska Institute, Sweden 

   Baylor University, TX, USA

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