Blood Pressure Usually Considered Normal Is Associated with an Elevated Risk of Cardiovascular Disease

This prospective cohort study used nearly 9,000 participants to examine whether blood pressure in the “prehypertensive” range — above normal but below the 140/90 mmHg threshold for hypertension — carried meaningful cardiovascular risk.

Prehypertensive individuals had significantly elevated cardiovascular disease risk compared to those with normal pressure. The gradient was steeper in high-risk subgroups: Black participants, those with diabetes, and those with elevated BMI faced substantially amplified risk even in the prehypertensive range — a subgroup effect that clinical practice often misses when applying uniform thresholds.

The clinical implication is that the binary hypertension cutoff misses continuous risk that begins well below 140/90. Blood pressure management for patients in these vulnerable subgroups cannot wait for a threshold to be crossed. The finding anticipated the 2017 ACC/AHA guideline shift to defining hypertension at 130/80 mmHg.

We rate the evidence strong. A substantial prospective cohort confirming the continuous nature of blood pressure risk below the traditional hypertension threshold, with specific implications for earlier intervention in higher-risk populations.