The “J Curve” Problem Revisited: Old and New Findings
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This paper critically addresses the issue of the “J-curve” paradox—the finding described in studies performed about 30 years ago indicating that treatment-induced systolic blood pressure values below 120 or 125 mm Hg and diastolic blood pressure values below 75 mm Hg are characterized by an increase, rather than a reduction, in the incidence of coronary events. This paper focuses on four major subjects: 1) the benefits of a lower blood pressure target during treatment; 2) the historical background of the “J-curve” phenomenon; 3) the evidence collected in recent clinical trials regarding the existence of a “J-curve” in treated hypertensive patients; and 4) the recent recommendations by the Task Force Committee of the European Society of Hypertension on blood pressure goals to be achieved during treatment.
- •• Mancia G, De Backer G, Dominiczak A, et al.: 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007, 25:1105–1187. This paper represents the official guidelines for the diagnosis and management of high blood pressure jointly issued by the ESH and ESC.
- Zanchetti A, Amery A, Berglund G, et al.: How much should blood pressure be lowered? The problem of the J-shaped curve. J Hypertens Suppl 1989, 7:S338–S348.
- •• Mancia G, Laurent S, Agabiti-Rosei E, et al.: Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009, 27:2121–2158. The ESH decided in 2009 to update the recommendations on hypertension management, based on the results of major clinical trials published in the period 2007 to 2009.
- Collins R, MacMahon S: Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease. Br Med Bull 1994, 50:272–298.
- Arima H, Chalmers J, Woodward M, et al.: Lower target blood pressures are safe and effective for the prevention of recurrent stroke: the PROGRESS trial. J Hypertens 2006, 24:1201–1208. CrossRef
- Bakris GL, Williams M, Dworkin L, et al.: Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis 2000, 36:646–661.
- UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998, 317:703–713.
- Berl T, Hunsicker LG, Lewis JB, et al.: Cardiovascular outcomes in the Irbesartan Diabetic Nephropathy Trial of patients with type 2 diabetes and overt nephropathy. Ann Intern Med 2003, 138:542–549.
- Estacio RO, Jeffers BW, Gifford N, Schrier RW: Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes. Diabetes Care 2000, 23(Suppl 2):B54–B64.
- Patel A; MacMahon S, Chalmers J, et al.: Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007, 370:829–840.
- Pepine CJ, Handberg EM, Cooper-DeHoff RM, et al.: A calcium antagonist vs a noncalcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA 2003, 290:2805–2816. CrossRef
- Fox KM, EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators: Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003, 362:782–788. CrossRef
- Nissen SE, Tuzcu EM, Libby P, et al.: Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study—a randomized controlled trial. JAMA 2004, 292:2217–2225. CrossRef
- Yusuf S, Sleight P, Pogue J, et al.: Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000, 342:145–153. CrossRef
- PROGRESS Collaborative Study Group: Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001, 358:1033–1041. CrossRef
- PATS Collaborating Group: Post-stroke antihypertensive treatment study. A preliminary result. Chin Med J (Engl) 1995, 108:710–717.
- Zanchetti A: To what level should blood pressure be brought by antihypertensive treatment? High Blood Press 1992, 1:197–200.
- Stewart IM: Relation of reduction in pressure to first myocardial infarction in patients receiving treatment for severe hypertension. Lancet 1979, 1(8121):861–865. CrossRef
- Cruickshank JM, Thorp JM, Zacharias FJ: Benefits and potential harm of lowering high blood pressure. Lancet 1987, 1(8533):581–584. CrossRef
- Alderman MH, Ooi WL, Madhavan S, Cohen H: Treatment-induced blood pressure reduction and the risk of myocardial infarction. JAMA 1989, 262:920–924. CrossRef
- Samuelsson O, Wilhelmsen L, Andersson OK, et al.: Cardiovascular morbidity in relation to change in blood pressure and serum cholesterol levels in treated hypertension. Results from the primary prevention trial in Göteborg, Sweden. JAMA 1987, 258:1768–1776. CrossRef
- Yusuf S, Diener HC, Sacco RL, et al.: Telmisartan to prevent recurrent stroke and cardiovascular events. N Engl J Med 2008, 359:1225–1237. CrossRef
- Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRANSCEND) Investigators: Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial. Lancet 2008, 372:1174–1183. CrossRef
- Julius S, Kjeldsen SE, Weber M, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004, 363:2022–2031. CrossRef
- Messerli FH, Mancia G, Conti CR, et al.: Dogma disputed: Can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med 2006, 144:884–893.
- • Sleight P, Redon J, Verdecchia P, et al.: Prognostic value of blood pressure in patients with high vascular risk in the Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial study. J Hypertens 2009, 27:1360–1369. This paper provides a new evaluation of the ONTARGET Study, analyzing the blood pressure goal data in relation to cardiovascular events in high-risk individuals.
- Bangalore S, Messerli FH, Wun C, et al.: J-Curve revisited: an analysis of the Treating to New Targets (TNT) Trial [poster 1039-70]. J Am Coll Cardiol 2009, 53:A217.
- Lewington S, Clarke R, Qizilbash N, et al.: Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002, 360:1903–1913. CrossRef
- •• Zanchetti A, Mancia G, Black HR, et al.: Facts and fallacies of blood pressure control in recent trials: implications in the management of patients with hypertension. J Hypertens 2009, 27:673–679. This editorial addresses some of the current clinical problems in hypertension management, with particular emphasis on the position of beta blockers.
- Boutitie F, Gueyffier F, Pocock S, et al.: J-shaped relationship between blood pressure and mortality in hypertensive patients: new insights from a meta-analysis of individual-patient data. Ann Intern Med 2002, 136:438–448.
- •• Zanchetti A, Grassi G, Mancia G: When should antihypertensive drug treatment be initiated and to what levels should systolic blood pressure be lowered? A critical reappraisal. J Hypertens 2009, 27:923–934. This is an updated analysis of the results of major clinical trials aimed at defining blood pressure levels at which antihypertensive treatment should start and blood pressure goals.
- Guideline Committee: 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003, 21:1011–1053.
- Liu L, Zhang Y, Liu G, et al.: The Felodipine Event Reduction (FEVER) Study: a randomized long-term placebo-controlled trial in Chinese hypertensive patients. J Hypertens 2005, 23:2157–2172. CrossRef
- Hypertension, Detection and Follow-up Program Cooperative Group: Five-year findings of the Hypertension Detection and Follow-up Program. III. Reduction in stroke incidence among persons with high blood pressure. JAMA 1982, 247:633–638. CrossRef
- Medical Research Council Working Party: MRC trial of treatment of mild hypertension: principal results. Br Med J 1985, 291:97–104. CrossRef
- Helgeland A: Treatment of mild hypertension: a five year controlled drug trial. The Oslo study. Am J Med 1980, 69:725–732. CrossRef
- Hansson L, Zanchetti A, Carruthers SG, et al.: Effects of intensive blood pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998, 351:1755–1762. CrossRef
- JATOS Study Group: Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res 2008, 31:2115–2127. CrossRef
- Schrier RW, Estacio RO, Esler A, Mehler P: Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and stroke. Kidney Int 2002, 61:1086–1097. CrossRef
- The Heart Outcomes Prevention Evaluation (HOPE) Study investigators: Effects of ramipril on cardiovascular and microvascular outcomes in MICROHOPE substudy. Lancet 2000, 355:253–259. CrossRef
- Pitt B, Byington RP, Furberg CD, et al.: Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000, 102:1503–1510.
- Poole-Wilson PA, Lubsen J, Kirwan BA, et al.: Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatment (ACTION trial): randomised controlled trial. Lancet 2004, 364:849–857. CrossRef
- The PEACE Trial Investigators: Angiotensin-converting-enzyme inhibition in stable coronary disease. N Engl J Med 2004, 351:2058–2068. CrossRef
- Schrader J, Luders S, Kulschewski A, et al.: The ACCESS Study: evaluation of Acute Candesartan Cilexetil Therapy in Stroke Survivors. Stroke 2003, 34:1699–1703. CrossRef
- The “J Curve” Problem Revisited: Old and New Findings
Current Hypertension Reports
Volume 12, Issue 4 , pp 290-295
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