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The J-shaped Curve for Blood Pressure and Cardiovascular Disease Risk: Historical Context and Recent Updates

  • Coronary Heart Disease (S. Virani and S. Naderi, Section Editors)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The definition and treatment of hypertension have both changed dramatically over the last century, with recent trials suggesting benefit for lower blood pressure (BP) targets than ever before considered. However, tempering the enthusiasm for more intensive BP targets are long-held concerns that BP reduction below a certain threshold may pose dangers, the so-called “J-curve.” In this review, we summarize the evidence for a J-curve in the treatment of hypertension.

Recent Findings

The Systolic Blood Pressure Intervention Trial (SPRINT) reported that achieving a systolic BP target of 120 mmHg reduces cardiovascular disease in high-risk individuals, supporting more intensive BP reduction. However, contemporary observational studies consistently demonstrate a BP J-curve, the threshold of which is often close to the SPRINT target. Studies also suggest that the BP level of this J-curve may vary based on patient characteristics, including age and comorbidities. There is also more compelling evidence for the specific presence of a J-curve between diastolic BP and coronary events, in contrast to conflicting evidence of a J-curve with systolic BP and cardiovascular disease more generally.

Summary

There is increased risk of coronary events below a diastolic BP of 60–70 mmHg. In comparison, the presence of a systolic J-curve is less clear and some persons at high risk may actually benefit from systolic levels down to 120 mmHg. Therefore, we suggest a personalized approach to BP management considering individual risks, benefits, and preferences when choosing therapeutic targets. Further, well-designed studies are required to support our suggestions and to define J-curve thresholds more clearly.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Faisal Rahman & John W. McEvoy

  2. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Faisal Rahman & John W. McEvoy

  3. Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    John W. McEvoy

  4. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524C, Baltimore, MD, 21287, USA

    John W. McEvoy

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Rahman, F., McEvoy, J.W. The J-shaped Curve for Blood Pressure and Cardiovascular Disease Risk: Historical Context and Recent Updates. Curr Atheroscler Rep 19, 34 (2017). https://doi.org/10.1007/s11883-017-0670-1

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