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The J-curve in hypertension

John Cruickshank1

  • 142 Harefield, Long Melford, Suffolk CO10 9DE, United Kingdom. johndtl@aol.com

Current Cardiology Reports
|October 16, 2003
PubMed

Insights

The J-curve effect in blood pressure management is often due to reverse causality. For most hypertensive patients, lowering diastolic blood pressure (DBP) to the low 80s is beneficial and safe, but not essential.

Area of Science:

  • Cardiology
  • Hypertension Management
  • Clinical Trials

Background:

  • The J-curve phenomenon, relating blood pressure to adverse events, has been debated for 25 years.
  • Observational studies have confounded the J-curve issue, with reverse causality often implicated.
  • Underlying conditions like poor cardiac function or arterial stiffness can cause both low blood pressure and increased event risk.

Purpose of the Study:

  • To clarify the J-curve debate using data from the prospective, randomized Hypertension Optimal Treatment (HOT) study.
  • To determine the optimal diastolic blood pressure (DBP) targets for hypertensive patients.
  • To investigate the J-curve relationship in patients with and without coronary artery disease.

Main Methods:

  • Analysis of the full publication data from the Hypertension Optimal Treatment (HOT) study.
  • Prospective, randomized trial design to minimize bias.
  • Evaluation of cardiovascular and noncardiovascular events in relation to treated diastolic blood pressure (DBP).

Main Results:

  • For non-ischemic hypertensive subjects, lowering DBP to the low 80s mm Hg is beneficial; further reduction is safe but unproductive.
  • In patients with coronary artery disease, a J-curve relationship exists between treated DBP and myocardial infarction risk.
  • No significant J-curve was observed for stroke risk in patients with coronary artery disease.

Conclusions:

  • The HOT study provides clear evidence on blood pressure targets, resolving much of the J-curve debate.
  • For most hypertensive patients, DBP can be safely lowered to the low 80s mm Hg.
  • In patients with coronary artery disease, maintaining DBP above the low 80s mm Hg is prudent to avoid myocardial infarction risk.

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