Document Detail

Hypertension, coronary heart disease and stroke: Should the blood pressure J-curve be a concern?
MedLine Citation:
PMID:  23351918     Owner:  NLM     Status:  Publisher    
The paradoxical increase in cardiovascular events in patients with treatment-induced low blood pressure (BP), particularly in hypertensives with pre-existing coronary artery disease, especially those with critically low diastolic BP, which conflicts with data from epidemiologic observational studies, is referred to as a J-curve. It was first described over 30 years ago and is still the subject of considerable controversy. Recent large clinical outcomes trials (INVEST, TNT, ONTARGET, PROVE IT-TIMI 22, SMART) and meta-analyses strongly support its existence for systolic and diastolic BP. The diastolic J-curve is commonly more pronounced. In contrast to cardiovascular complications related to coronary artery disease, no J-curve phenomenon was noted for stroke in most of these studies. This is explained by differences in cerebral and coronary autoregulation and because coronary perfusion occurs only during diastole. On the basis of this review, we suggest a cautious, individualized approach to treatment, particularly in hypertensive patients with coronary heart disease or high risk for impaired coronary blood flow. In these patients we advise against treatment that lowers systolic BP below 120-125 mmHg and, particularly, diastolic BP below 70-75 mmHg.
José Braz Nogueira
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-22
Journal Detail:
Title:  Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology     Volume:  -     ISSN:  0870-2551     ISO Abbreviation:  Rev Port Cardiol     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8710716     Medline TA:  Rev Port Cardiol     Country:  -    
Other Details:
Languages:  ENG; POR     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.
Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal. Electronic address:
Vernacular Title:
Hipertensão arterial, doença coronária e acidente vascular cerebral. A curva em J deve preocupar-nos?
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