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Can treating the diastolic blood pressure below a certain value increase cardiovascular risk?

Norman M Kaplan1

  • 1University of Texas Southwestern Medical School, Dallas, TX 75390-8586, USA. norman.kaplan@utsouthwestern.edu

Current Cardiology Reports
|August 17, 2011
PubMed

Insights

Lowering diastolic blood pressure below 65 mm Hg with antihypertensive drugs can increase cardiovascular events, a phenomenon known as a J-curve. This risk is heightened in patients with coronary heart disease, necessitating careful treatment strategies.

Area of Science:

  • Cardiology
  • Hypertension Management
  • Vascular Medicine

Background:

  • The J-curve phenomenon describes an increased risk of cardiovascular events when diastolic blood pressure (DBP) falls below a critical threshold.
  • Antihypertensive medications are widely used to manage high blood pressure, but their efficacy and safety at lower DBP levels require careful consideration.

Purpose of the Study:

  • To highlight the potential risks associated with intensive blood pressure lowering.
  • To emphasize the importance of avoiding the J-curve phenomenon in hypertensive patients, especially those with coronary heart disease.

Main Methods:

  • Review of extensive data and clinical evidence regarding diastolic blood pressure thresholds.
  • Analysis of cardiovascular event rates in relation to DBP levels achieved with antihypertensive therapy.

Main Results:

  • A J-curve effect is consistently observed when DBP is lowered below 65 mm Hg by antihypertensive medication.
  • This increased risk is particularly pronounced in patients with underlying, even subclinical, coronary heart disease.

Conclusions:

  • Intensive and widespread treatment of hypertension requires caution to prevent adverse cardiovascular outcomes.
  • Monitoring and individualized treatment strategies are crucial to avoid the J-curve phenomenon and ensure patient safety.

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