Current status of aggressive blood pressure control

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Hypertension treatment has evolved significantly, from neglect to aggressive control.
• Recent evidence suggests overly aggressive blood pressure reduction may be detrimental.
• The J-curve effect, where low diastolic blood pressure increases cardiovascular risk, is a growing concern.

Purpose of the Study:

• To review the current understanding of the J-curve effect in hypertension management.
• To explore the association between low blood pressure levels and cardiovascular events.
• To discuss the differential impact of blood pressure fluctuations on the heart and brain.

Main Methods:

• A Medline literature search was conducted from 1992 to 2010.
• Eleven pertinent articles were selected for review.
• Collateral literature was also included for a comprehensive discussion.

Main Results:

• Low diastolic blood pressure is associated with increased cardiovascular events (J-curve effect).
• The heart's vulnerability to diastolic blood pressure fluctuations is exacerbated by coronary heart disease and left ventricular hypertrophy.
• The J-curve effect has also been observed with systolic blood pressure, though less frequently than with diastolic pressure.

Conclusions:

• Aggressive blood pressure control may not always be beneficial and can be associated with adverse cardiovascular outcomes.
• Understanding the J-curve effect is crucial for optimizing hypertension treatment strategies.
• The autoregulation mechanisms of the brain differ from the heart, influencing their susceptibility to blood pressure variations.