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Effectiveness of lowering blood pressure to prevent stroke versus to prevent coronary events

Steven G Chrysant1, George S Chrysant

  • 1Oklahoma Cardiovascular and Hypertension Center and the University of Oklahoma, Oklahoma City, Oklahoma, USA. schrysant@yahoo.com

The American Journal of Cardiology
|September 7, 2010
PubMed

Insights

The J-curve effect links low blood pressure (BP) to increased cardiovascular risks, challenging the "lower the better" approach. This review found evidence for the J-curve effect in cardiovascular disease but not stroke complications.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Clinical Outcomes

Background:

  • The J-curve effect describes an inverse relationship between low blood pressure (BP) and cardiovascular complications.
  • This effect is primarily observed with low diastolic BP (70-80 mm Hg), influenced by conditions like coronary artery disease and hypertension.
  • Current guidelines recommend aggressive BP control, but recent trials question the

Purpose of the Study:

  • To review the evidence regarding the J-curve effect in relation to blood pressure control and cardiovascular complications.
  • To evaluate the consistency of the J-curve effect across different cardiovascular outcomes and stroke.
  • To assess the implications of recent clinical trials on aggressive blood pressure management strategies.

Main Methods:

  • A Medline search of English-language reports published between 1992 and 2010 was conducted.
  • Eleven selected reports were reviewed, along with collateral published research.
  • The review focused on studies investigating the J-curve effect concerning blood pressure and cardiovascular events.

Main Results:

  • Most reviewed publications suggest a J-curve effect for cardiovascular disease complications associated with low diastolic and systolic blood pressure.
  • Recent large clinical trials have observed a J-curve effect with diastolic BP <80 mm Hg and systolic BP <130 mm Hg.
  • No J-curve effect was consistently noted for stroke complications in contrast to cardiovascular events.

Conclusions:

  • The J-curve effect appears relevant for cardiovascular disease complications, indicating potential risks with very low blood pressure.
  • The findings cast doubt on the universal

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