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What should be the optimal levels of blood pressure: Does the J-curve phenomenon really exist?

Maciej Banach1, Marta Michalska, Sverre E Kjeldsen

  • 1Medical University of Lodz, WAM University Hospital in Lodz, Department of Hypertension, Zeromskiego 113, 90-549 Lodz, Poland. maciejbanach@aol.co.uk.

Expert Opinion on Pharmacotherapy
|April 27, 2011
PubMed

Insights

Careful blood pressure reduction is crucial for patients with hypertension and coronary artery disease. Lowering blood pressure (BP) too much may increase cardiovascular events, highlighting the need for individualized treatment strategies.

Area of Science:

  • Cardiology
  • Hypertension Management
  • Clinical Trials

Background:

  • The long-standing debate on blood pressure (BP) J-curves persists, with recent evidence suggesting cautious BP reduction in hypertensive patients with coronary artery disease.
  • A BP threshold of 110-115/70-75 mmHg is proposed as a potential safety limit to avoid increased cardiovascular events.

Purpose of the Study:

  • To analyze the implications of intensive blood pressure lowering in patients with hypertension, particularly those with diabetes and coronary artery disease.
  • To evaluate the risks and benefits of intensive BP management strategies based on existing trial data.

Main Methods:

  • Retrospective analysis of the INternational VErapamil-SR/Trandolapril STudy (INVEST) Trial.
  • Review of the blood pressure arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial.

Main Results:

  • The ACCORD BP Trial indicated benefits in stroke reduction with intensive treatment but showed no overall advantage on major endpoints.
  • Intensive BP treatment in the ACCORD Trial was associated with an increased risk of adverse events in hypertensive patients with diabetes.

Conclusions:

  • Existing observational studies and randomized trials (e.g., BBB, HOT, ACCORD BP) are inconclusive due to limited statistical power.
  • Further research is essential to definitively address the BP J-curve phenomenon.
  • In high-risk hypertensive patients, careful patient selection is necessary to identify those who may benefit from intensive BP lowering versus those at risk for adverse events.
Abstract

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