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[Hypertension and cardiovascular risk: the J-curve concept]

A Yannoutsos1, J-J Mourad, Jacques Blacher

  • 1Unité Hypertension Artérielle, Prévention et Thérapeutique Cardiovasc., Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu, Université Paris.

Praxis
|November 5, 2010
PubMed

Insights

Optimizing pharmacologic treatment for hypertension is crucial due to high prevalence and poor blood pressure control. Lowering blood pressure reduces cardiovascular risk, but overly strict goals may be detrimental.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Hypertension is prevalent, especially in the elderly, with over half of patients lacking adequate blood pressure control.
  • Associated cardiovascular risk factors and residual risk under treatment necessitate optimized pharmacologic strategies.
  • Interventional studies demonstrate a cardiovascular risk reduction proportional to blood pressure lowering.

Purpose of the Study:

  • To evaluate the optimal blood pressure targets in hypertensive patients.
  • To address the controversies surrounding strict blood pressure goals and the J-Curve phenomenon.

Main Methods:

  • Review of interventional studies and clinical trials on hypertension management.
  • Analysis of guidelines for blood pressure targets in different patient populations.
  • Examination of the J-Curve concept regarding cardiovascular morbidity and mortality.

Main Results:

  • Current guidelines suggest targets below 140/90 mmHg for essential hypertension and below 130/80 mmHg for secondary prevention (e.g., diabetes, renal impairment).
  • Clinical trials do not consistently confirm the benefit of strict blood pressure goals in high-risk patients; potentially deleterious effects observed.
  • The "lower the better" concept is being reconsidered due to the J-Curve hypothesis.

Conclusions:

  • The optimal blood pressure target in hypertension requires careful consideration, balancing benefits of reduction against potential risks of overly strict goals.
  • The J-Curve phenomenon, suggesting increased risk with very low blood pressure, remains an area of ongoing research and debate.
  • Individualized treatment strategies are essential for managing hypertension and its associated cardiovascular risks.

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