The J-curve in arterial hypertension: fact or fallacy?

Area of Science:

• Cardiology
• Hypertension Management

Background:

• A significant number of patients with arterial hypertension remain undertreated, contributing to increased cardiovascular event rates.
• Conversely, overly aggressive blood pressure reduction can paradoxically elevate cardiovascular events, a phenomenon known as the J-curve.

Purpose of the Study:

• To review the J-curve phenomenon in hypertension management.
• To identify patient populations at risk for adverse outcomes with aggressive blood pressure lowering.
• To discuss updated guideline recommendations for safer blood pressure targets.

Main Methods:

• Literature review of studies on blood pressure management and cardiovascular outcomes.
• Analysis of the J-curve phenomenon in specific patient subgroups.
• Examination of current European hypertension guidelines.

Main Results:

• The J-curve phenomenon, where excessively low blood pressure increases cardiovascular events, is observed in patients with coronary artery disease and left ventricular hypertrophy when diastolic blood pressure falls below 70-80 mm Hg or systolic below 130 mm Hg.
• This phenomenon is not typically seen in patients with stroke or renal disease.
• Recent guidelines suggest higher blood pressure targets for specific patient groups, including the elderly and those with certain cardiovascular conditions.

Conclusions:

• A conservative blood pressure management strategy is crucial for patients with coronary artery disease, left ventricular hypertrophy, the elderly, and isolated systolic hypertension.
• Adherence to updated European Society of Hypertension/European Society of Cardiology guidelines is recommended for optimizing patient outcomes.
• Individualized blood pressure targets are essential to balance the risks of undertreatment and overtreatment.