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Blood pressure targets in the treatment of high blood pressure: a reappraisal of the J-shaped phenomenon

A Corrigendum to this article was published on 08 January 2014

This article has been updated

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.

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  • 08 January 2014

    This article has been corrected since online publication and a corrigendum is also printed in this issue.

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Acknowledgements

This study was supported, in part, by the National Institute of Science and Technology for Health Technology Assessment (IATS)—CNPq/Brazil.

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Correspondence to F D Fuchs.

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Fuchs, F., Fuchs, S. Blood pressure targets in the treatment of high blood pressure: a reappraisal of the J-shaped phenomenon. J Hum Hypertens 28, 80–84 (2014). https://doi.org/10.1038/jhh.2013.78

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