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Prehypertension is a considerable health risk, particularly in people aged 45 and older

Prehypertension—an elevation in blood pressure that is a risk factor for heart attack, heart failure, stroke, and kidney disease—is estimated to be responsible for 9.1 percent of U.S. deaths, 6.5 percent of nursing home stays, and 3.4 percent of hospital stays each year for people ages 25 to 74, according to new research funded by the Agency for Healthcare Research and Quality (HS07002 and HS11477).

Blood pressure is recorded as two numbers—the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats). Hypertension is defined as a systolic pressure of 140 mmHg or higher over a diastolic pressure of 90 mmHg or higher. Both numbers are important, but in May 2003, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), from the National Heart, Lung, and Blood Institute recommended systolic pressure, or the top number, as the better indicator of risk for other health problems. The JNC 7 identified prehypertension as having a systolic blood pressure between 120 mmHg and 139 mmHg, and defined residual hypertension as continuing to have a systolic pressure of 140 mmHg or higher despite treatment.

AHRQ's new study estimates that as many as two-thirds of people between the ages of 45 and 64 and 80 percent of people between the ages of 65 and 74 may have prehypertension or residual hypertension. The researchers found that, per 10,000 adults between the ages of 25 and 74, prehypertension and residual hypertension together account for almost 14 percent of deaths, nearly 10 percent of nursing home admissions, and 4.7 percent of hospital admissions.

The researchers found that women between the ages of 65 and 74 would benefit most if prehypertension and residual hypertension were eliminated. Hospital admission rates among women could drop by almost 150 admissions per 10,000 women in this age group. Men also show substantial reductions in risk. Hospital admission rates could drop by 85 admissions per 10,000 for men ages 45 to 64 and by 62 admissions per 10,000 for men 65 to 74.

Researchers Louise B. Russell, Ph.D., and Elmira Valiyeva, Ph.D., of Rutgers University and Jeffrey L. Carson, M.D., of the University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School, used a simulation model based on the National Health and Nutrition Examination Surveys I and III to estimate the impact of prehypertension and residual hypertension on deaths, nursing home admissions, and hospitalizations for adults in the United States between the ages of 25 and 74.

For more information, see "Effects of prehypertension on admissions and deaths: A simulation," by Drs. Russell, Valiyeva, and Carson, in the October 25, 2004, Archives of Internal Medicine 164, pp. 2119-2124.

Editor's Note: For online access to the JNC 7 guidelines and related materials, go to

Select to access information and materials on preventive services programs, which include prevention and management of hypertension.

Information about the President's HealthierUS initiative can be found at

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