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The J-curve revisited: a therapeutic dilemma

Edward J Filippone1, Andrew Foy

  • 1Department of Medicine, Division of Nephrology, Thomas Jefferson University, Philadelphia, PA 18145, USA. kidneys@comcast.net

Cardiology in Review
|March 27, 2012
PubMed

Insights

The hypertension J-curve shows increased cardiovascular risk when diastolic blood pressure (BP) drops too low, especially in coronary heart disease (CHD) patients. Recent studies support this phenomenon, impacting treatment strategies.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Clinical Medicine

Background:

  • The J-curve phenomenon describes an increased risk of cardiovascular events when diastolic blood pressure (BP) falls below a specific threshold.
  • This concept has been debated for over 30 years, particularly concerning its relevance in hypertension treatment.

Purpose of the Study:

  • To review the existing literature on the J-curve phenomenon in hypertension treatment.
  • To discuss the pathophysiology and evidence supporting or refuting the J-curve.
  • To explore the clinical implications for managing hypertension in high-risk populations.

Main Methods:

  • Comprehensive literature review of studies investigating the relationship between diastolic BP and cardiovascular outcomes.
  • Analysis of post hoc data from large contemporary randomized trials, particularly in patients with coronary heart disease (CHD).

Main Results:

  • Recent analyses of major randomized trials in patients with documented CHD provide strong evidence supporting the existence of the J-curve.
  • The J-curve suggests that excessively low diastolic BP may increase cardiovascular morbidity and mortality.

Conclusions:

  • The J-curve phenomenon is supported by contemporary evidence, particularly in patients with established coronary heart disease.
  • Strict blood pressure control in hypertension requires careful consideration of the potential risks associated with achieving very low diastolic BP levels, especially in high-risk patients.

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