Blood pressure management in secondary prevention after myocardial infarction

The management of blood pressure (BP) in secondary prevention after acute myocardial infarction (AMI) remains a matter of debate. Since no dedicated trials have specifically addressed BP control in patients recovering from an acute coronary syndrome, there are no evidence-based, prospective data to define precise BP targets in this population. Moreover, major international guidelines devote surprisingly little attention to BP management in the post-AMI setting, despite its recognized importance in reducing recurrent cardiovascular events. On one hand, BP-lowering may improve cardiac function by reducing afterload and myocardial oxygen consumption and by facilitating favourable ventricular remodelling. On the other hand, the concept of a J-shaped association-whereby excessive lowering of diastolic blood pressure may paradoxically increase cardiovascular risk, particularly in the early post-AMI period-remains a matter of ongoing uncertainty. Despite decades of investigation, this issue has not been definitively resolved and continues to raise debate within both the scientific community and among clinicians. In this review, we examine the current evidence supporting BP control in the context of secondary prevention following AMI, with an updated focus on the ongoing debate surrounding the potential implications of the J-shaped phenomenon.