Borderline hypertension

Borderline hypertension is a widespread condition and because of its large prevalence, it has a major impact on the cardiovascular mortality of the po pulation. A modest elevation of blood pressure in borderline hypertension i s closely associated with multiple theologic, hemodynamic, humoral and meta bolic abnormalities. Many of these abnormalities, independently of the bloo d pressure, increase the coronary risk in patients with borderline hyperten sion. There is no sufficient evidence in the literature to propose a well structu red algorithm of management and treatment of borderline hypertension. Establishing a reliable baseline blood pressure (by ambulatory or home bloo d pressure monitoring) is the first step in the management of borderline hy pertension. One year of intensive nonpharmacologic treatment is recommended as the first therapeutic modality. If this fails to decrease the blood pre ssure, pharmacologic treatment with small doses of antihypertensive medicat ion is recommended in patients with dyslipidemia or in patients whose out o f office blood pressure remains elevated.