Drug treatment of prehypertension: Not now, not ever?

People with prehypertension undoubtedly have an increased risk of cardiovascular and other complications. The vast majority have low absolute risk and whether drug treatment would be beneficial is uncertain. While pharmacotherapy has attractions from a public health prospective, clinicians and crucially those with prehypertension require robust evidence that drug treatment will lead to short-term as well as long-term gains. Any changes in recommendations should await adequately powered outcome studies, which provide solid evidence of the magnitude of absolute risk reduction in treating prehypertension and assessment of the cost-effectiveness.