Vol 8, No 3 (2004)
Review paper
Published online: 2004-06-04
J-curve - myth or reality?
Wojciech Sobiczewski, Andrzej Rynkiewicz
Nadciśnienie tętnicze 2004;8(3):191-195.
Vol 8, No 3 (2004)
REVIEV
Published online: 2004-06-04
Abstract
Fundamental purpose of therapy in hypertensive patients is reduction of blood pressure and prevention of cardiovascular morbidity and mortality associated with hypertension. Despite many achievements in hypotensive
therapy hypertensive patients are still at increased risk of cardiovascular morbidity and mortality. Reasonable is affirmation
that intensive therapy will bring more benefits in this group of patients. However there is J curve theory
suggesting, that excessive drop of blood pressure, below certain level can increase cardiovascular risk, especially in hypertensive patients with coronary heart disease. Discussion
about existence of J curve relationship has lasted for near 25 years, still raising many doubts, which have been initiated by Steward and Cruickshank publications. Despite
numerous criticism of research suggesting harmful capability of excessive blood pressure reduction, J curve relationship still remains unsolved. Prospective studies in the
late ‘80 and in ‘90 which were conducted to give final explanation of J curve theory and supply answers how far in clinical practice we should lower blood pressure to achieve maximal benefit of hypotensive thrapy. HOT study was the research everybody hoped will explain J curve problem. However, authors did not reach the answer concerning J curve relationship between blood pressure reduction and cardiovascular risk. Analysis of results of INVEST study has supplied apologists of this theory next arguments confirming J curve existence which were presented by Franz Messerli on this years Congress of American Society of Cardiology.
So after analysis of many clinical trials especially INVEST study the conclusion that excessive blood pressure reduction among hypertensive patients with coronary heart disease
may increase risk of myocardial infarction seems to be reasonable.
Abstract
Fundamental purpose of therapy in hypertensive patients is reduction of blood pressure and prevention of cardiovascular morbidity and mortality associated with hypertension. Despite many achievements in hypotensive
therapy hypertensive patients are still at increased risk of cardiovascular morbidity and mortality. Reasonable is affirmation
that intensive therapy will bring more benefits in this group of patients. However there is J curve theory
suggesting, that excessive drop of blood pressure, below certain level can increase cardiovascular risk, especially in hypertensive patients with coronary heart disease. Discussion
about existence of J curve relationship has lasted for near 25 years, still raising many doubts, which have been initiated by Steward and Cruickshank publications. Despite
numerous criticism of research suggesting harmful capability of excessive blood pressure reduction, J curve relationship still remains unsolved. Prospective studies in the
late ‘80 and in ‘90 which were conducted to give final explanation of J curve theory and supply answers how far in clinical practice we should lower blood pressure to achieve maximal benefit of hypotensive thrapy. HOT study was the research everybody hoped will explain J curve problem. However, authors did not reach the answer concerning J curve relationship between blood pressure reduction and cardiovascular risk. Analysis of results of INVEST study has supplied apologists of this theory next arguments confirming J curve existence which were presented by Franz Messerli on this years Congress of American Society of Cardiology.
So after analysis of many clinical trials especially INVEST study the conclusion that excessive blood pressure reduction among hypertensive patients with coronary heart disease
may increase risk of myocardial infarction seems to be reasonable.
Keywords
J-curve; arterial hypertension; coronary heart disease; myocardial infarction
Title
J-curve - myth or reality?
Journal
Arterial Hypertension
Issue
Vol 8, No 3 (2004)
Article type
Review paper
Pages
191-195
Published online
2004-06-04
Page views
803
Article views/downloads
1096
Bibliographic record
Nadciśnienie tętnicze 2004;8(3):191-195.
Keywords
J-curve
arterial hypertension
coronary heart disease
myocardial infarction
Authors
Wojciech Sobiczewski
Andrzej Rynkiewicz