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Antihypertensive therapy and the J-curve: fact or fiction?
Monique S Tanna1, Sripal Bangalore
1Leon H. Charney Division of Cardiology, New York University School of Medicine, 530 First Avenue, SKI 9R/109, New York, NY, 10016, USA.
Insights
Determining the optimal blood pressure target for hypertension management remains challenging. Optimal targets vary by organ, with cardiac protection favoring higher systolic blood pressure (130-140 mmHg) and cerebrovascular protection favoring lower levels (110-120 mmHg).
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Hypertension is a significant modifiable risk factor for cardiovascular disease.
- Despite extensive research, optimal blood pressure targets for hypertension treatment lack consensus.
- The J-curve phenomenon, suggesting adverse outcomes at both low and high blood pressures, is debated.
Purpose of the Study:
- To investigate the optimal blood pressure targets in patients with hypertension.
- To explore the concept of target organ heterogeneity in relation to blood pressure goals.
- To clarify the existence and implications of the J-curve phenomenon in hypertension management.
Main Methods:
- Review of existing epidemiologic studies and clinical evidence.
- Analysis of outcomes related to different blood pressure targets.
- Comparison of evidence for cardiac versus cerebrovascular protection.
Main Results:
- Evidence does not support systolic blood pressure goals below 130-140 mmHg for cardiac protection.
- Lower blood pressure targets, down to 110-120 mmHg systolic, appear beneficial for cerebrovascular protection.
- The J-curve phenomenon's validity is dependent on the specific target organ.
Conclusions:
- Optimal blood pressure targets in hypertension are organ-dependent.
- The J-curve phenomenon is context-specific, not universally applicable.
- Personalized blood pressure management strategies considering target organs are crucial.
Abstract:
Hypertension is a major modifiable risk factor for cardiovascular morbidity and mortality. Despite more than five decades of hypertension treatment, there still exist both a lack of evidence and a clear consensus to answer a fundamental question: What is the optimal blood pressure target in patients with hypertension? Early epidemiologic studies suggested the notion of the lower the blood pressure, the better the outcomes; however, others have demonstrated a J-curve phenomenon with worse outcomes at both low and very high blood pressures. Although the existence of such a J-curve remains a topic of debate, there is now increasing recognition of target organ heterogeneity wherein the optimal blood pressure depends on the target organ in question. For cardiac protection, the current body of evidence does not support a systolic blood pressure goal of lower than 130-140 mmHg. For cerebrovascular protection, however, lower blood pressure seems to be better with a sustained reduction in events down to a systolic blood pressure of 110-120 mmHg. The J-curve phenomenon is therefore both fact and fiction based on the target organ in question.
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