Key result
A review of the literature and recent post hoc analyses strongly support the existence of a J-curve, where decreasing diastolic blood pressure below a certain nadir increases cardiovascular risk.
Why the study?
Does lowering diastolic blood pressure below a certain threshold increase cardiovascular morbidity and mortality in hypertensive patients?
Does lowering diastolic blood pressure below a certain threshold increase cardiovascular morbidity and mortality in hypertensive patients?
This review emphasizes the clinical importance of the J-curve phenomenon, suggesting that excessively low diastolic blood pressure during hypertension treatment may increase cardiovascular risk, particularly in patients with coronary heart disease.
Very low DBP may increase CV risk in CHD patients; supports J-curve yet leaves optimal targets unresolved pending RCTs.
The J-curve in hypertension treatment refers to the relationship between achieved diastolic blood pressure (BP) and cardiovascular morbidity and mortality, specifically related to coronary heart disease (CHD). As diastolic BP decreases below a certain threshold or nadir, the risk of cardiovascular events increases. This phenomenon was first described over 30 years ago and its significance has been debated ever since. We review in detail the literature for and against the existence of this J-curve and discuss its purported pathophysiology. Most notably, recent post hoc analyses of large contemporary randomized trials in patients with documented CHD strongly support its existence. Given the current emphasis on strict BP control, especially in high-risk patients like those with CHD, diabetes, and chronic kidney disease, we discuss the implications this J-curve may have for treating hypertension in the individual patient.
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Filippone et al. (2012) conducted a review in Hypertension and coronary heart disease. Low achieved diastolic blood pressure was evaluated on Cardiovascular morbidity and mortality. A review of the literature and recent post hoc analyses strongly support the existence of a J-curve, where decreasing diastolic blood pressure below a certain nadir increases cardiovascular risk.
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