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The J-curve between blood pressure and coronary artery disease or essential hypertension: exactly how essential?

Franz H Messerli1, Gurusher S Panjrath

  • 1Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, New York 10019, USA. FMesserli@aol.com.

Journal of the American College of Cardiology
|November 7, 2009
PubMed

Insights

The J-curve effect shows that very low diastolic blood pressure can increase coronary artery disease risk, especially in treated patients. Aggressive hypertension control is still vital despite this complex relationship.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Clinical Medicine

Background:

  • The relationship between blood pressure and coronary artery disease (CAD) has been debated, with some studies suggesting an inverse correlation between diastolic pressure and cardiac events.
  • This inverse relationship, where lower diastolic pressure correlates with higher risk, is particularly noted in patients with existing CAD.
  • The coronary arteries receive their primary blood supply during diastole, making them vulnerable to reduced perfusion from excessively low diastolic pressure.

Purpose of the Study:

  • To explore the controversial J-curve phenomenon linking diastolic blood pressure and coronary artery disease.
  • To examine the implications of this relationship for managing hypertension in patients with and without established CAD.
  • To address the clinical dilemma physicians face when balancing stroke/renal protection with potential myocardial ischemia risk.

Main Methods:

  • Review of existing literature and large clinical trials examining diastolic pressure and coronary events.
  • Analysis of the physiological basis for diastolic pressure's role in coronary perfusion.
  • Evaluation of the J-shaped relationship in treated patients with CAD.

Main Results:

  • Numerous studies confirm an inverse relationship between diastolic pressure and adverse cardiac ischemic events.
  • A J-shaped curve is frequently observed in treated CAD patients, indicating increased risk with lower diastolic pressures.
  • The coronary circulation's reliance on diastolic perfusion makes it susceptible to harm from excessive diastolic pressure reduction.

Conclusions:

  • Excessively low diastolic pressure can precipitate myocardial ischemia, posing a risk in CAD patients.
  • Physicians must carefully consider this J-curve effect when lowering blood pressure to prevent stroke or renal disease.
  • Despite concerns, aggressive hypertension control remains crucial, as current treatment targets are met by only a minority of patients.

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