The J-Curve Phenomenon and the Treatment of Hypertension: Is There a Point Beyond Which Pressure Reduction Is Dangerous?

Lisa Farnett, Cynthia D. Mulrow, William D. Linn, Catherine R. Lucey, Michael R. Tuley

Research output: Contribution to journalArticlepeer-review

400 Scopus citations

Abstract

We critically appraised the medical literature to evaluate whether there is a point beyond which blood pressure reduction in hypertensive subjects is no longer beneficial and possibly even deleterious. Thirteen studies that stratified cardiovascular outcomes by level of achieved blood pressure in treated hypertensive subjects who had been followed up for at least 1 year were critiqued by four independent reviewers. Data addressing population, protocol, and methodological characteristics were evaluated. Studies did not show a consistent J-shaped relationship between treated blood pressure and stroke, but they did demonstrate a consistent J-shaped relationship for cardiac events and diastolic blood pressure. The beneficial therapeutic threshold point was 85 mm Hg. We conclude that low treated diastolic blood pressure levels, ie, below 85 mm Hg, are associated with increased risk of cardiac events.

Original languageEnglish (US)
Pages (from-to)489-495
Number of pages7
JournalJAMA: The Journal of the American Medical Association
Volume265
Issue number4
DOIs
StatePublished - Jan 23 1991

ASJC Scopus subject areas

  • General Medicine

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