The J-shaped Curve for Blood Pressure and Cardiovascular Disease Risk: Historical Context and Recent Updates

AbstractPurpose of ReviewThe definition and treatment of hypertension have both changed dramatically over the last century, with recent trials suggesting benefit for lower blood pressure (BP) targets than ever before considered. However, tempering the enthusiasm for more intensive BP targets are long-held concerns that BP reduction below a certain threshold may pose dangers, the so-called “J-curve.” In this review, we summarize the evidence for a J-curve in the treatment of hypertension.Recent FindingsThe Systolic Blood Pressure Intervention Trial (SPRINT) reported that achieving a systolic BP target of 120  mmHg reduces cardiovascular disease in high-risk individuals, supporting more intensive BP reduction. However, contemporary observational studies consistently demonstrate a BP J-curve, the threshold of which is often close to the SPRINT target. Studies also suggest that the BP level of this J-curv e may vary based on patient characteristics, including age and comorbidities. There is also more compelling evidence for the specific presence of a J-curve between diastolic BP and coronary events, in contrast to conflicting evidence of a J-curve with systolic BP and cardiovascular disease more gene rally.SummaryThere is increased risk of coronary events below a diastolic BP of 60 –70 mmHg. In comparison, the presence of a systolic J-curve is less clear and some persons at high risk may actually benefit from systolic levels down to 120 mmHg. Therefore, we suggest a pers...
Source: Current Atherosclerosis Reports - Category: Cardiology Source Type: research