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Antihypertensive Therapy and the J-curve: Fact or Fiction?

  • Antihypertensive Agents: Mechanisms of Drug Action (ME Ernst, Section Editor)
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Abstract

Hypertension is a major modifiable risk factor for cardiovascular morbidity and mortality. Despite more than five decades of hypertension treatment, there still exist both a lack of evidence and a clear consensus to answer a fundamental question: What is the optimal blood pressure target in patients with hypertension? Early epidemiologic studies suggested the notion of the lower the blood pressure, the better the outcomes; however, others have demonstrated a J-curve phenomenon with worse outcomes at both low and very high blood pressures. Although the existence of such a J-curve remains a topic of debate, there is now increasing recognition of target organ heterogeneity wherein the optimal blood pressure depends on the target organ in question. For cardiac protection, the current body of evidence does not support a systolic blood pressure goal of lower than 130–140 mmHg. For cerebrovascular protection, however, lower blood pressure seems to be better with a sustained reduction in events down to a systolic blood pressure of 110–120 mmHg. The J-curve phenomenon is therefore both fact and fiction based on the target organ in question.

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Conflict of Interest

Monique S. Tanna declares no conflicts of interest.

Sripal Bangalore reports grants and personal fees from Abbott Vascular and personal fees from Abbott, Boehringer Ingelheim, Daiichi Sankyo, Pfizer, Gilead, and Merck.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Leon H. Charney Division of Cardiology, New York University School of Medicine, 530 First Avenue, SKI 9R/109, New York, NY, 10016, USA

    Monique S. Tanna & Sripal Bangalore

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  1. Monique S. Tanna
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  2. Sripal Bangalore
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Correspondence to Sripal Bangalore.

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This article is part of the Topical Collection on Antihypertensive Agents: Mechanisms of Drug Action

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Tanna, M.S., Bangalore, S. Antihypertensive Therapy and the J-curve: Fact or Fiction?. Curr Hypertens Rep 17, 6 (2015). https://doi.org/10.1007/s11906-014-0516-y

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