What is prehypertension and how to reverse it?

Reversing prehypertension into normal blood pressure

What is prehypertension?

Prehypertension means the previous step of getting hypertension. It is less than the hypertension blood pressure range and it warns you that there is a chance to get hypertension and other related cardiovascular diseases.

Who introduced the prehypertension category?

Prehypertension is a term that was first introduced by JNC- 7 [1]The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC … Continue reading in 2003. The reason they introduced this blood pressure category is because of the risk of having high blood pressure, cardiovascular diseases, and renal diseases in the future.

In the world about 31 % people have prehypertension.  Also, the prevalence of prehypertension in men is higher than in women. If you are a male, then be aware of your blood pressure all the time.

If we prevent prehypertension, it will not be progressed into hypertension and the risk of getting cardiovascular diseases will be reduced.

prehypertension blood pressure range

The prehypertension blood pressure range is defined as systolic blood pressure from 120 – 139mmHg diastolic blood pressure from 80 – 89 mmHg (systolic blood pressure is the upper number of your blood pressure, diastolic blood pressure is the below number of your blood pressure). Prehypertension blood pressure means, that you have the risk of having high blood pressure and other cardiovascular diseases in the future. So it is basically a warning sign that says be aware.

Prehypertension diagnosis

The only way to detect prehypertension is to measure your blood pressure. Blood pressure measurement is a non-invasive measurement which means it won’t heart you to measure blood pressure. It will take only a few minutes to do it. You can ask your health care provider to measure your blood pressure or you can do it at home if you have a blood pressure monitor at home (usually these are automatic blood pressure monitors where you only have to press a button to know your blood pressure.

To correctly detect prehypertension you need to measure your blood pressure two or more times (duplicates or triplicates) while properly seating,  on two or more occasions/ visits to the health care provider. Then you need to take the average of those duplicate or triplicate measurements. If the calculated average blood pressure measurements fall into the prehypertensive category at both times, then it is considered as having prehypertension.

Systolic and diastolic prehypertension

If your systolic and diastolic blood pressure fell into two different categories of blood pressure, then your blood pressure belongs to the category to which the higher number of blood pressure belongs.

As an example, if your diastolic blood pressure belongs to the normal category, but your systolic blood pressure belongs to the prehypertensive category, you should consider that your blood pressure belongs to the prehypertensive category. Some people call this systolic prehypertension because your systolic blood pressure is elevated while the diastolic blood pressure is normal.

The other situation is having a diastolic blood pressure of prehypertension range and systolic blood pressure in the normal range. In this situation also you should be considered as having prehypertension. Some also call this diastolic prehypertension.

Prehypertension guidelines

For your convenience, I have included below the different blood pressure categories according to JNC 7.

Blood pressure category Systolic blood pressure (mmHg) Diastolic blood pressure (mmHg)
Normal <120 <80
Prehypertension 120 – 139 80 – 89
Hypertension ≥ 140 ≥ 90
Stage 1 140 – 159 90-99
Stage 2 160-179 100-109
Stage 3 ≥180 ≥110
Table 01: Blood pressure classification according to JNC 7 guidelines

However, there is a new guideline to classify blood pressure. That guideline is from ACC/AHA [2]Whelton PK, et al: 2017 ACC/AHA/AAPA/ABC/ACPM/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation andmanagement of high blood pressure in adults. J Am Coll Cardiol 71: … Continue reading.

This is the most recent guideline for blood pressure classification which was introduced in 2017. According to this guideline, the prehypertensive category was split into two and classified as elevated blood pressure and hypertension. You can get a clear idea by looking at the following blood pressure chart.

Blood pressure category Systolic blood pressure (mmHg) Diastolic blood pressure (mmHg)
Normal <120 and <80
Elevated 120-129 <80
Stage 1 130-139 80-89
Stage 2 >130-139 >90
Table 02: Blood pressure classification according to ACC/AHA guidelines

If you are diagnosed with prehypertension (elevated blood pressure or stage 1 hypertension), there is a chance to progress it into hypertension in the next 4 years, if you did not do anything. So you need to act upon the situation before it becomes the real burden.

Prehypertension causes

                                                    An unhealthy diet that leads to prehypertension

There are many causes of prehypertension. The main causes are our genes and our lifestyle. Following are some lifestyle factors that cause our blood pressure to elevate and cause prehypertension.

  • Taking high sodium foods regularly
  • The habit of eating fewer fruits and vegetables
  • Smoking
  • Being physically inactive
  • Stress
  • Obesity

Prehypertension signs and symptoms

Prehypertension usually does not have any signs and symptoms, like hypertension. That is why hypertension is known as the “silent killer”. Because of this, it is hard to detect prehypertension without measuring blood pressure. However, if you have a risk for prehypertension such as being overweight, unhealthy diet, and physically inactive, it is better to check your blood pressure and know your number.

Prehypertension medicine?

For the treatment of prehypertension, only lifestyle and behavioral modifications are recommended. To manage prehypertension we don’t need to get a bunch of medications. All we have to do is change our lifestyle.

5 ways to reverse prehypertension

Following are prehypertension guidelines that you can follow to reverse or cure it. This basically means by doing the following you can lower your blood pressure to a normal range.

1# Follow the DASH diet (Dietary Approaches to Stop Hypertension)

                                                     DASH diet for prehypertension/hypertension

DASH diet is a dietary treatment for prehypertension. It can be used as a prehypertension diet. DASH diet is rich in potassium (daily potassium requirement is 4.7g) and calcium. Also, it has less saturated fat, meat, and sweets. According to research DASH, the diet was able to reduce systolic blood pressure by 5.5 mmHg and diastolic blood pressure by 3.0 mmHg.

In research where the DASH diet was tested for prehypertensives, prehypertension was reduced to normal blood pressure in 62% of individuals.

You might have heard about the DASH diet, However, if I explain it in simple words, it recommends taking the following serving sizes from some food groups;

  • 4 -5 servings of fruits per day.
  • 4 – 5 servings of vegetables per day
  • 2-3 low-fat dairy products per day

Some of the fruits and vegetables that you can eat in the DASH diet are leafy green vegetables, fruits, and root vegetables. Some examples of foods in these food groups are oranges, beet greens, spinach, sweet potatoes, banana, and white beans.

It is better if you can take less than 25% calories from fat daily. It will also benefit to take 2g or more fish oil per day.

Also do not forget to drink 8 – 10 cups of water/fluids per day.

#2 Reduce your body weight

                                                     Losing weight will reduce your blood pressure

Reducing blood pressure does not mean that you have to come to your normal BMI level. According to a meta-analysis, if you reduce 1 kilogram of weight, you will reduce 1 mmHg of blood pressure if you are prehypertensive. If you are already obese or overweight, try to lose body weight.

#3 Take less sodium

                                                               Eat less salt (only eat 1tsp per day)

Sodium or salt you take every day affects your blood pressure. There are plenty of studies that suggest, reduced sodium intake can reduce your blood pressure. If you reduce 76mmol/L  per day, it will reduce your blood pressure by 2/1 mmHg. You might think that reducing the amount of salt is hard, but once you get used to it, you will be able to do it effortlessly. 

It is recommended to take less than 2300mg of sodium per day. This amount is equivalent to 1 tsp of salt. This means that you can add only one teaspoon of salt when you are preparing meals.

Another way to reduce your salt intake is by consuming less processed foods. Also, make sure that you READ THE LABELS of any food that you purchase. When you go to a supermarket and looking for processed foods, see the amount of salt/sodium in them and you can avoid the high sodium/salt food. However, limiting those processed foods will be your best choice.

You can limit the times you are eating out, make most of your meals at home, and change the way you are preparing foods.

#4 Do physical activities regularly

                                               Doing aerobic activities will lower your blood pressure

There are plenty of studies in the literature, that suggest regular physical activities help to reduce blood pressure. Even if you are a male or a female or at any age, doing physical activities will help you to reduce blood pressure. If you have prehypertension, doing physical activities will reduce your systolic blood pressure by 3 -4 mmHg.

You can do moderate-intensity, aerobic/ moderate-intensity physical activities for 30 min or more most days a week. This means that you have to do physical activities for a minimum of 90 to 150 minutes. You can also do muscle-strengthening activities that include all major muscle groups.

#5 Only take alcohol in moderation

Drink less alcohol

If you limit your alcohol intake you will be able to reduce your systolic blood pressure by 3.5 mmHg. This means you can take up to 2 drinks (24 oz of beer, 10 oz of
wine, or 2 oz of 80-proof whiskey) of alcohol per day if you are a man and 1 drink per day if you are a woman, to manage prehypertension.

All the ways I have mentioned before for the prehypertension version is for adults with prehypertension. If you used all the strategies I mentioned above in combination, you will be able to reduce blood pressure more and have normal blood pressure again.

Can you get prehypertension in your 20s?

Even if you are in your twenties, there is a chance for you to get prehypertension or elevated blood pressure. Because of this, it is very important to check your blood pressure if you are above the age of 20.


Dilini Tharaka

Dilini Tharaka

BSc. (sp.) in Food Science and Nutrition, Specializing in Applied Nutrition (Founder, Editor, and an Author)
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