Prehypertension was a term coined by JNC 7. Prehypertension is the result of ‘life style syndrome’ – consuming too much calories and having too little physical activity. Association of diabetes increase the risk associated with prehypertension. Persons with prehypertension have higher levels of resistin and lower levels of adiponectin. Vascular damage starts in the prehypertensive phase. Role of of life style modification in prehypertension is well known. Earlier clinical outcome trials have not demonstrated benefits of drug therapy in prehypertension. TROPHY trial was one of the first trials of drug therapy of prehypertension. The active treatment arm was on candesartan. The end point was development of hypertension. There was a reduction in development of new hypertension in the active treatment arm. One of the criticisms on the trial was that a good number had features of metabolic syndrome which placed them in high risk group. IVUS substudy of CAMELOT showed better reduction of coronary atheroma progression in prehypertensives. As of now, benefit of treating isolated prehypertension has not been substantiated, but in those with associated risk factors like diabetes has to be considered. The emphasis to be first on life style modifications in prehypertension.