How Far Should Blood Pressure Be Lowered?

WHEN doctors prescribe antihypertensive drugs they face a dilemma. They are well aware that the benefits of lowering blood pressure in patients with hypertension far outweigh the risks, yet they have been warned that at some level of lowered blood pressure the tables turn and the risks become dominant. The initial downward slope of the mortality rate and the subsequent upward slope when the blood pressure gets too low form the so-called J curve. Our argument, presented here, is not that the J curve does not exist, but rather that the putative cause- and-effect relation between the reduction in blood . . .