title: Blood pressure targets in the treatment of high blood pressure: a reappraisal of the J-shaped phenomenon.
abstract: The risk that lowering blood pressure (BP) excessively increases the incidence of cardiovascular disease-the J-shaped phenomenon-has been a matter of concern endorsed by many experts, particularly in patients with coronary heart disease and diabetes. The results of the Action to Control Cardiovascular Risk in Type 2 Diabetes (ACCORD) trial strengthened the idea that it may be futile to lower BP more intensively in patients with diabetes. Nevertheless, there seems to be no direct J-shaped relation between BP-lowering treatment and outcome. Patients with normal or low BP and high or very high cardiovascular risk could have their BP reduced further by treatment. Placebo-controlled clinical trials of BP-lowering agents in patients with BP within normal values and concomitant cardiovascular disease demonstrated consistent reduction of recurrent and newer cardiovascular events. The use of BP agents in such conditions, as in patients with coronary artery disease, heart failure, diabetes and in patients recovered from a stroke has been endorsed by guidelines. Although is likely that there is a J-shaped relationship of BP with outcomes in cohort studies, clinical trials that tested more intensive versus standard goals and clinical trials done with patients with low BP demonstrated that the J-shaped phenomenon should not be a concern in the treatment of high BP.
authors: National Institute of Science and Technology for Health Technology Assessment (IATS)-CNPq, Hospital de Clinicas de Porto Alegre, UFRGS, Porto Alegre, Brazil.
authors: F D
authors: FD
authors: Fuchs
authors: National Institute of Science and Technology for Health Technology Assessment (IATS)-CNPq, Hospital de Clinicas de Porto Alegre, UFRGS, Porto Alegre, Brazil.
authors: S C
authors: SC
authors: Fuchs
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
references: Arch Intern Med. 2012 Aug 13;172(15):1162-8
references: 22801930
references: Circulation. 2011 Nov 29;124(22):2458-73
references: 22052934
references: Lancet. 1998 Jun 13;351(9118):1755-62
references: 9635947
references: Expert Rev Cardiovasc Ther. 2004 Sep;2(5):771-5
references: 15350178
references: Lancet. 2003 Sep 6;362(9386):782-8
references: 13678872
references: Lancet. 1987 Mar 14;1(8533):581-4
references: 2881129
references: JAMA. 1991 Jan 23-30;265(4):489-95
references: 1824642
references: Hypertension. 2011 Jun;57(6):1039-40
references: 21555679
references: Lancet. 2001 Sep 29;358(9287):1033-41
references: 11589932
references: Vasc Health Risk Manag. 2012;8:437-42
references: 22870036
references: N Engl J Med. 2010 Apr 29;362(17):1575-85
references: 20228401
references: N Engl J Med. 1992 Sep 3;327(10):685-91
references: 1463530
references: Hypertension. 2002 Jan;39(1):105-10
references: 11799087
references: N Engl J Med. 1992 Sep 3;327(10):669-77
references: 1386652
references: Eur J Cardiovasc Prev Rehabil. 2011 Jun;18(3):369-77
references: 21450638
references: J Hum Hypertens. 2009 Jan;23(1):27-32
references: 18650839
references: J Am Geriatr Soc. 1999 Dec;47(12):1415-21
references: 10591234
references: N Engl J Med. 1991 Aug 1;325(5):293-302
references: 2057034
references: N Engl J Med. 1987 Jun 4;316(23):1429-35
references: 2883575
references: Cardiovasc Drugs Ther. 2000 Aug;14(4):373-9
references: 10999643
references: Arch Intern Med. 2001 May 14;161(9):1183-92
references: 11343441
references: Trials. 2011 Mar 05;12:65
references: 21375762
references: Ann Intern Med. 2006 Jun 20;144(12):884-93
references: 16785477
references: Heart. 1999 Oct;82(4):477-81
references: 10490564
references: BMJ. 2009 May 19;338:b1665
references: 19454737
references: J Hypertens. 2011 Jul;29(7):1253-69
references: 21505352
references: BMJ. 1989 May 20;298(6684):1356-7
references: 2502252
references: J Hypertens. 2009 Nov;27(11):2121-58
references: 19838131
references: Lancet. 1979 Apr 21;1(8121):861-5
references: 86103
references: Lancet. 2002 Dec 14;360(9349):1903-13
references: 12493255
references: JAMA. 2003 May 21;289(19):2560-72
references: 12748199
references: Hypertension. 2012 Aug;60(2):326-32
references: 22753208
references: N Engl J Med. 2008 May 1;358(18):1887-98
references: 18378519
references: Arch Intern Med. 2012 Sep 24;172(17):1296-303
references: 22868819
references: BMJ. 1994 Mar 12;308(6930):681-6
references: 8142790
references: J Hypertens. 2011 Oct;29(10):1889-96
references: 21857536
references: Lancet. 1978 Nov 25;2(8100):1139-41
references: 82694
references: Hypertension. 2011 Jun;57(6):1061-8
references: 21555676
references: N Engl J Med. 2000 Jan 20;342(3):145-53
references: 10639539
references: Lancet. 2000 Jan 22;355(9200):253-9
references: 10675071
references: JAMA. 2011 Mar 2;305(9):913-22
references: 21364140