The "J curve" problem revisited: old and new findings.
This paper critically addresses the issue of the "J-curve" paradox--the finding described in studies performed about 30 years ago indicating that treatment-induced systolic blood pressure values below 120 or 125 mm Hg and diastolic blood pressure values below 75 mm Hg are characterized by an increase, rather than a reduction, in the incidence of coronary events. This paper focuses on four major subjects: 1) the benefits of a lower blood pressure target during treatment; 2) the historical background of the "J-curve" phenomenon; 3) the evidence collected in recent clinical trials regarding the existence of a "J-curve" in treated hypertensive patients; and 4) the recent recommendations by the Task Force Committee of the European Society of Hypertension on blood pressure goals to be achieved during treatment.
Grassi
Guido
G
Clinica Medica, Ospedale S. Gerardo dei Tintori, Via Pergolesi 33, 20052, Monza, Milan, Italy. guido.grassi@unimib.it
Quarti-Trevano
Fosca
F
Dell'Oro
Raffaella
R
Mancia
Giuseppe
G
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000503:physiopathology*; D014943:Global Health; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D007558:Italy / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012307:Risk Factors
D000959:Antihypertensive Agents