Prehypertension is a part of the continuum from normotension to hypertension it is a part of a dynamic process of stiffening and aging of the arteries and of the heart with its consequences. Patients in the prehypertensive range will become finally hypertensive. Diseased arteries will not only participate in propagation of end organ damage but will enhance the progression of additional damage in the arteries and the heart. Understanding the risk of borderline conditions in the metabolic syndrome will enable us to understand the nature of end organ damage and will create a possibility of better prevention of this continuous process.

Prehypertension is usually associated with other components of the metabolic syndrome i.e. obesity, diabetes, glucose intolerance and dyslipidemia. This association is due to common mechanistic pathways and has implications on cardiovascular complications. Diet and exercise with or without drug therapy benefit all components of the metabolic syndrome. Antihypertensive medications may lead to deterioration in glucose tolerance while glucose lowering agents may affect blood pressure. Thus, any discussion about the approach to prehypertension must be done in context to the whole cardio metabolic risk.