Intensive blood pressure lowering below 130/80 mmHg may be associated with a J-curve phenomenon, increasing the risk of adverse cardiovascular events in high-risk hypertensive patients.
Does aggressive blood pressure lowering exhibit a J-curve relationship with outcomes in hypertensive patients?
Current evidence suggests a J-curve relationship for blood pressure lowering, supporting a target range of 130-139/80-85 mmHg and caution with further reductions, especially in high-risk patients.
The blood pressure (BP) J-curve debate started in 1979, and we still cannot definitively answer all the questions. However, available studies of antihypertensive treatment provide strong evidence for J-shaped relationships between both diastolic and systolic BP and main outcomes in the general population of hypertensive patients, as well as in high-risk populations, including subjects with coronary artery disease, diabetes mellitus, left ventricular hypertrophy, and elderly patients. However, further studies are still necessary in order to clarify this issue. This is connected to the fact that most available studies were observational, and randomized trials did not have or lost their statistical power and were inconclusive. Perhaps only the Systolic Blood Pressure Intervention Trial (SPRINT) and Optimal Blood Pressure and Cholesterol Targets for Preventing Recurrent Stroke in Hypertensives (ESH-CHL-SHOT) will be able to finally answer all the questions. According to the current state of knowledge, it seems reasonable to suggest lowering BP to values within the 130-139/80-85 mmHg range, possibly close to the lower values in this range, in all hypertensive patients and to be very careful with further BP level reductions, especially in high-risk hypertensive patients.
Banach et al. (2012) conducted a review in Hypertension. Intensive blood pressure lowering vs. Standard blood pressure lowering was evaluated. Intensive blood pressure lowering below 130/80 mmHg may be associated with a J-curve phenomenon, increasing the risk of adverse cardiovascular events in high-risk hypertensive patients.