title: What are the implications for the community of the discrepancy between the theory and practice of BP control?
abstract: Epidemiological data suggest that the lower the BP, the lower the cardiovascular risk. This is true across a broad range of BP levels, including those considered 'normal'; more than half of all cardiovascular events attributed to raised BP occur when DBP is < or = 95 mmHg. The belief that lowering BP too far is harmful is based on the hypothesis of a J-shaped relationship between BP and risk of cardiovascular disease. The weight of evidence now clearly suggests, however, that the J-shaped curve is not a consequence of treatment, but of underlying cardiovascular dysfunction that reduces BP and increases morbidity and mortality. Current prospective observational data give no evidence of a threshold BP below which there is no further reduction in cardiovascular disease risk. The average BP reductions in randomised trials are 5-6 mmHg (diastolic) and 10-12 mmHg (systolic), which would be expected to reduce the incidence of stroke by 35% and of coronary heart disease by 21%. If average BP reductions were doubled, prospective observational studies suggest the cardiovascular risk would be reduced by a further 15-20%.
authors.affiliation: Department of Community Health, School of Medicine, University of Auckland, New Zealand.
authors.forename: R
authors.initials: R
authors.lastname: Jackson
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D003327:Coronary Disease / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008955:Models, Cardiovascular; D011364:Professional Practice; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents