J Curve in Hypertension.

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.