Cardiovascular Drugs and Therapy

, Volume 8, Issue 5, pp 757–760 | Cite as

J curve in antihypertensive therapy—Does it exist? A personal point of view

  • J. M. Cruickshank
State-Of-The-Art Lectures

Summary

Coronary flow is maintained in the face of changing perfusion pressure (approximates to diastolic blood pressure [DBP]) by the process of autoregulation. A normal coronary artery is able to dilate fivefold (coronary flow reserve of 5); by contrast, coronary flow reserve falls in the presence of left ventricular hypertrophy [LVH] and/or coronary artery disease. Thus a fall in DBP that is normally well tolerated causes a fall in coronary flow, ECG changes, and left ventricular dysfunction in the presence of LVH and coronary artery disease. Such high-risk patients exhibit a J-curve relationship between DBP and death from coronary artery disease; lowering DBP (phase 5) to below the mid 80s would be imprudent in such patients.

Key Words

J curve high risk hypertensives autoregulation coronary flow reserve left ventricular hypertrophy coronary artery disease 

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Copyright information

© Kluwer Academic Publishers 1994

Authors and Affiliations

  • J. M. Cruickshank
    • 1
  1. 1.The Flat, The BowsWilmslow ParkUK

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