title: The j-point phenomenon in aggressive therapy of hypertension: new insights.
abstract: In the era of aggressive control of cardiovascular risk factors such as hypertension, the mantra of "lower is better" has taken a strong foothold. Although there is clear epidemiologic evidence that lower blood pressure improves specific organ-related outcomes, this rule does not apply to all patients and definitely not all target organs. The concept of J-curve or adverse outcomes at lower blood pressure has been proposed for more than three decades but has recently come under increasing scrutiny. Specifically, a relationship between adverse cardiovascular outcomes and low diastolic blood pressure has been observed in multiple clinical trials. In this article we review the advances in understanding of the J-curve phenomenon and include a discussion on specific populations that might be at higher risk due to the J-curve relationship.
authors.affiliation: The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. gpanjra1@jhmi.edu
authors.forename: Gurusher S
authors.initials: GS
authors.lastname: Panjrath
authors.forename: Sameer
authors.initials: S
authors.lastname: Chaudhari
authors.forename: Franz H
authors.initials: FH
authors.lastname: Messerli
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001795:Blood Pressure Determination / Q000592:standards; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D002320:Cardiovascular Physiological Phenomena / Q000187:drug effects; D003971:Diastole / Q000187:drug effects* / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005544:Forecasting; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D007022:Hypotension / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012015:Reference Standards; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents