, Volume 6, Issue 4, pp 281-290

J Curve in Hypertension

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The relationship between blood pressure and cardiovascular disease risk among treated hypertensives is J-shaped: risk is increased at high levels of blood pressure, falls in parallel with blood pressure reduction and increases again when blood pressure falls below a nadir (the point at which blood pressure is too low to maintain perfusion of vital organs). Randomized controlled trials of antihypertensive treatment have identified J-shaped relationships between achieved systolic and diastolic blood pressures and all-cause mortality, as well as fatal and nonfatal cardiovascular events, but not stroke or renal outcomes, in the general population of hypertensives and high-risk prehypertensives, particularly in subgroups such as the elderly and those with coronary artery disease, chronic kidney disease, diabetes, left ventricular hypertrophy, and high cardiovascular risk because of multiple comorbidities and concomitant risk factors. Blood pressure targets <130–140/70–85 mm Hg were not beneficial for any outcome except stroke and chronic kidney disease.