title: What should be the optimal levels of blood pressure: Does the J-curve phenomenon really exist?
abstract: BACKGROUND
  The blood pressure (BP) J-curve debate has lasted for over 30 years and we still cannot definitively answer all the questions. However, recent studies suggest that BP should be reduced carefully in patients with hypertension and coronary artery disease. BP should not fall below 110 - 115/70 - 75 mmHg, because this may be associated with more cardiovascular events.
  
  
  METHODS
  A retrospective analysis of the INVEST Trial and the results of the BP arm of the ACCORD Trial shows that care is needed in patients with hypertension and diabetes. Although the ACCORD BP Trial suggests important benefits connected with the significant reduction of stroke in patients being treated intensively, it also shows the lack of advantage of such therapy on each main and other additional endpoints. The ACCORD Trial also confirmed the increased risk of adverse events that might appear when intensive treatment was used in this group of patients.
  
  
  CONCLUSIONS
  Most available studies were observational and randomized trials (BBB, HOT, ACCORD BP), do not have or have lost their statistical power and were inconclusive. Further studies are therefore needed to provide definitive conclusions on the subject. In the meantime, it seems that in high-risk patients with hypertension, it is necessary to carefully select those who might suffer adverse events and those who may benefit from intensive BP lowering.
authors.affiliation: Medical University of Lodz, WAM University Hospital in Lodz, Department of Hypertension, Zeromskiego 113, 90-549 Lodz, Poland. maciejbanach@aol.co.uk.
authors.forename: Maciej
authors.initials: M
authors.lastname: Banach
authors.forename: Marta
authors.initials: M
authors.lastname: Michalska
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.forename: Jolanta
authors.initials: J
authors.lastname: Małyszko
authors.forename: Dimitri P
authors.initials: DP
authors.lastname: Mikhailidis
authors.forename: Jacek
authors.initials: J
authors.lastname: Rysz
mesh_terms: D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D016903:Drug Monitoring; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D007022:Hypotension / Q000139:chemically induced / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012016:Reference Values; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents