The diastolic blood pressure J-curve revisited: An update

Area of Science:

• Cardiology
• Clinical Medicine
• Hypertension Research

Background:

• Hypertension is a major cause of illness and death.
• Current guidelines emphasize strict systolic blood pressure (SBP) targets, potentially ignoring low diastolic blood pressure (DBP).
• A 'J-curve' phenomenon suggests increased adverse events when DBP drops below a critical threshold.

Purpose of the Study:

• To review observational studies from the past decade on the DBP J-curve in hypertension.
• To analyze evidence regarding the causative role of low DBP versus reverse causality.
• To consider implications for hypertension treatment intensification.

Main Methods:

• Systematic review of observational studies and post-hoc analyses of randomized controlled trials (RCTs).
• Focus on studies published in the last decade, with consideration of earlier data.
• Analysis of evidence for causation versus reverse causality in the DBP J-curve.

Main Results:

• The DBP J-curve phenomenon is observed in hypertension management.
• Uncertainty persists whether low DBP is directly causative or a marker of comorbidity.
• Data suggest a potential causal link in patients with documented coronary artery disease (CAD), possibly mitigated by revascularization.

Conclusions:

• The DBP J-curve exists, but its interpretation remains debated.
• Further randomized controlled trials (RCTs) are necessary to clarify the role of low DBP in cardiovascular risk.
• Current data are insufficient to make firm recommendations on intensifying therapy based on low DBP, especially in patients with CAD.