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J Curve in Hypertension

Tanja Dudenbostel1, Suzanne Oparil2

  • 1Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA, 933 19th Street S, Community Health Services Building (CHSB), Room 115, Birmingham, AL 35294-2041, USA.

Current Cardiovascular Risk Reports
|January 23, 2018
PubMed

Insights

The J-shaped curve shows that very low blood pressure in treated hypertensives can increase cardiovascular disease risk. Lowering blood pressure too much is not always beneficial.

Area of Science:

  • Cardiology
  • Hypertension Management

Background:

  • The relationship between blood pressure and cardiovascular disease (CVD) risk in treated hypertensives is complex.
  • A J-shaped relationship indicates increased risk at both high and very low blood pressure levels.

Purpose of the Study:

  • To analyze the J-shaped relationship between blood pressure and CVD risk in treated hypertensive patients.
  • To evaluate the impact of achieved blood pressure levels on mortality and cardiovascular events.

Main Methods:

  • Review of randomized controlled trials (RCTs) of antihypertensive treatments.
  • Analysis of J-shaped relationships between systolic and diastolic blood pressures and various health outcomes.

Main Results:

  • J-shaped relationships were observed for all-cause mortality and fatal/nonfatal cardiovascular events.
  • This pattern was noted in general hypertensive populations and high-risk subgroups, including the elderly, and those with specific conditions like coronary artery disease, chronic kidney disease, and diabetes.
  • Blood pressure targets below 130-140/70-85 mm Hg showed no benefit for most outcomes, except for stroke and chronic kidney disease.

Conclusions:

  • Achieving very low blood pressure levels in treated hypertensives may increase CVD risk.
  • Current blood pressure targets may need re-evaluation, especially for specific patient subgroups, to avoid potential harm from over-lowering blood pressure.

Keywords:
Chronic kidney diseaseComorbiditiesCoronary artery diseaseDiastolicElderlyMorbidityMortalitySystolic

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