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.
Clinica Medica, Ospedale S. Gerardo dei Tintori, Via Pergolesi 33, 20052, Monza, Milan, Italy. guido.grassi@unimib.it
Guido
G
Grassi
Fosca
F
Quarti-Trevano
Raffaella
R
Dell'Oro
Giuseppe
G
Mancia
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