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Treatment of Hypertension and the J Curve
1Clinical Hypertension Research, Department of Public Health and Social Sciences, University of Uppsala, Uppsala, Sweden.
Insights
Lowering high blood pressure effectively reduces cardiovascular risks. The Hypertension Optimal Treatment (HOT) study investigated optimal blood pressure reduction targets to minimize hypertension-related complications.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Trials
Background:
- Current hypertension treatments often fail to fully reduce cardiovascular morbidity and mortality.
- Treated hypertensive patients remain at elevated risk for stroke and myocardial infarction.
- Suboptimal blood pressure reduction may explain persistent cardiovascular risks in treated patients.
Purpose of the Study:
- To determine the optimal blood pressure reduction for minimizing hypertension-related cardiovascular risks.
- To investigate the potential benefits of more vigorous blood pressure lowering.
- To explore the implications of the J-shaped risk curve in hypertension management.
Main Methods:
- Review of existing studies on blood pressure reduction and cardiovascular risk.
- Analysis of findings from the Hypertension Optimal Treatment (HOT) study.
- Discussion of the J-curve phenomenon in relation to blood pressure treatment targets.
Main Results:
- The HOT study provides insights into achieving optimal blood pressure control.
- Evidence suggests a potential for greater cardiovascular benefit with more aggressive blood pressure lowering.
- The J-curve relationship indicates risks associated with excessively low blood pressure.
Conclusions:
- Optimal hypertension management requires careful consideration of blood pressure targets.
- Further research and clinical trials are needed to refine treatment strategies.
- Balancing blood pressure reduction is crucial to avoid both undertreatment and overtreatment risks.
Abstract:
The optimal reduction in blood pressure when treating hypertension is obviously the one which reduces hypertension related cardiovascular morbidity and mortality as much as possible. Today's approach to the treatment of high blood pressure usually does not achieve this goal. In other words, treated hypertensive patients are still at increased risk of cardiovascular complications, such as strokes and myocardial infarcts, in spite of being treated with antihypertensive drugs. One possible explanation for this could be that the treated blood pressure rarely is brought down to strictly normotensive levels, as shown in numerous studies. This would suggest that a more vigorous lowering of blood pressure would provide greater benefit when treating hypertensive patients. On the other hand, the fact that the relationship between the level of blood pressure and risk may be J shaped suggests that vigorous lowering of blood pressure may increase cardiovascular risks, if blood pressure is brought down too far. A few open, retrospective, nonrandomized studies and one randomized placebo controlled study in the elderly (SHEP) have analyzed this issue. The Hypertension Optimal Treatment (HOT) study,1,2 which was published in June 1998,3 has addressed this problem in a prospective randomized trial. The discussions around the J curve with some emphasis on the HOT study will be briefly reviewed. (c)1999 by Le Jacq Communications, Inc.