Skip to main content
Erschienen in: Current Cardiovascular Risk Reports 4/2012

01.08.2012 | Hypertension (P Hamet, Section Editor)

J Curve in Hypertension

verfasst von: Tanja Dudenbostel, Suzanne Oparil

Erschienen in: Current Cardiovascular Risk Reports | Ausgabe 4/2012

Einloggen, um Zugang zu erhalten

Abstract

The relationship between blood pressure and cardiovascular disease risk among treated hypertensives is J-shaped: risk is increased at high levels of blood pressure, falls in parallel with blood pressure reduction and increases again when blood pressure falls below a nadir (the point at which blood pressure is too low to maintain perfusion of vital organs). Randomized controlled trials of antihypertensive treatment have identified J-shaped relationships between achieved systolic and diastolic blood pressures and all-cause mortality, as well as fatal and nonfatal cardiovascular events, but not stroke or renal outcomes, in the general population of hypertensives and high-risk prehypertensives, particularly in subgroups such as the elderly and those with coronary artery disease, chronic kidney disease, diabetes, left ventricular hypertrophy, and high cardiovascular risk because of multiple comorbidities and concomitant risk factors. Blood pressure targets <130–140/70–85 mm Hg were not beneficial for any outcome except stroke and chronic kidney disease.
Literatur
1.
Zurück zum Zitat Build and Blood Pressure. Chicago: Society of Actuaries, Vol. 1; 1959. Build and Blood Pressure. Chicago: Society of Actuaries, Vol. 1; 1959.
2.
Zurück zum Zitat Lew EA. High blood pressure, other risk factors and longevity: the insurance viewpoint. Am J Med. 1973;55:281–94.PubMedCrossRef Lew EA. High blood pressure, other risk factors and longevity: the insurance viewpoint. Am J Med. 1973;55:281–94.PubMedCrossRef
3.
Zurück zum Zitat Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.PubMedCrossRef Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.PubMedCrossRef
4.
Zurück zum Zitat Blood Pressure Lowering Treatment Trialists Collaboration. Effects of different blood-pressure lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomized trials. Lancet. 2003;362:1527–35.CrossRef Blood Pressure Lowering Treatment Trialists Collaboration. Effects of different blood-pressure lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomized trials. Lancet. 2003;362:1527–35.CrossRef
5.
Zurück zum Zitat Stewart IM. Relation of reduction in pressure to first myocardial infarction in patients receiving treatment for severe hypertension. Lancet. 1979;313:861–5.CrossRef Stewart IM. Relation of reduction in pressure to first myocardial infarction in patients receiving treatment for severe hypertension. Lancet. 1979;313:861–5.CrossRef
6.
Zurück zum Zitat •• Cruickshank JM, Thorp JM, Zacharias FJ. Benefits and potential harm of lowering high blood pressure. Lancet. 1987;329:581–4. In this study the term J-curve is used for the first time for the non-linear relationship between BP and cardiovascular risk..CrossRef •• Cruickshank JM, Thorp JM, Zacharias FJ. Benefits and potential harm of lowering high blood pressure. Lancet. 1987;329:581–4. In this study the term J-curve is used for the first time for the non-linear relationship between BP and cardiovascular risk..CrossRef
7.
Zurück zum Zitat • Farnett L, Mulrow CD, Linn WD, Lucey CR, Tuley MR. The J-curve phenomenon and the treatment of hypertension. Is there a point beyond which pressure reduction is dangerous? JAMA. 1991;265:489–95.PubMedCrossRef • Farnett L, Mulrow CD, Linn WD, Lucey CR, Tuley MR. The J-curve phenomenon and the treatment of hypertension. Is there a point beyond which pressure reduction is dangerous? JAMA. 1991;265:489–95.PubMedCrossRef
8.
Zurück zum Zitat Williams B. Hypertension and the J-curve. JACC. 2009;54:1835–6.PubMed Williams B. Hypertension and the J-curve. JACC. 2009;54:1835–6.PubMed
9.
Zurück zum Zitat Canty Jr JM. Coronary pressure-function and steady-state pressure-flow relations during autoregulation in the unanesthetized dog. Circ Res. 1988;63:821–36.PubMedCrossRef Canty Jr JM. Coronary pressure-function and steady-state pressure-flow relations during autoregulation in the unanesthetized dog. Circ Res. 1988;63:821–36.PubMedCrossRef
10.
Zurück zum Zitat Polese A, De Cesare N, Montorsi P, Fabbiocchi F, Guazzi M, Loaldi A, Guazzi MD. Upward shift of the lower range of coronary flow autoregulation in hypertensive patients with hypertrophy of the left ventricle. Circulation. 1991;83:845–53.PubMedCrossRef Polese A, De Cesare N, Montorsi P, Fabbiocchi F, Guazzi M, Loaldi A, Guazzi MD. Upward shift of the lower range of coronary flow autoregulation in hypertensive patients with hypertrophy of the left ventricle. Circulation. 1991;83:845–53.PubMedCrossRef
11.
Zurück zum Zitat Lucas SJ, Tzeng YC, Galvin SD, Thomas KN, Ogoh S, Ainslie PN. Influence of changes in blood pressure on cerebral perfusion and oxygenation. Hypertension. 2010;55:698–705.PubMedCrossRef Lucas SJ, Tzeng YC, Galvin SD, Thomas KN, Ogoh S, Ainslie PN. Influence of changes in blood pressure on cerebral perfusion and oxygenation. Hypertension. 2010;55:698–705.PubMedCrossRef
12.
Zurück zum Zitat Loutzenhiser R, Griffin K, Williamson G, Bidani A. Renal autoregulation: new perspectives regarding the protective and regulatory roles of the underlying mechanisms. Am J Physiol Regul Integr Comp Physiol. 2006;290:R1153–67.PubMedCrossRef Loutzenhiser R, Griffin K, Williamson G, Bidani A. Renal autoregulation: new perspectives regarding the protective and regulatory roles of the underlying mechanisms. Am J Physiol Regul Integr Comp Physiol. 2006;290:R1153–67.PubMedCrossRef
13.
Zurück zum Zitat Berglund G. Goals of hypertensive therapy: is there a point beyond which pressure reduction is dangerous? Am J Hypertens. 1989;2:586–93.PubMed Berglund G. Goals of hypertensive therapy: is there a point beyond which pressure reduction is dangerous? Am J Hypertens. 1989;2:586–93.PubMed
14.
Zurück zum Zitat Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA. 1991;265:3255–64. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA. 1991;265:3255–64.
15.
Zurück zum Zitat Somes GW, Pahor M, Shorr RI, Cushman WC, Applegate WB. The role of diastolic blood pressure when treating isolated systolic hypertension. Arch Intern Med. 1999;159:2004–9.PubMedCrossRef Somes GW, Pahor M, Shorr RI, Cushman WC, Applegate WB. The role of diastolic blood pressure when treating isolated systolic hypertension. Arch Intern Med. 1999;159:2004–9.PubMedCrossRef
16.
Zurück zum Zitat Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhäger WH, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet. 1997;350:757–64.PubMedCrossRef Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhäger WH, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet. 1997;350:757–64.PubMedCrossRef
17.
Zurück zum Zitat Fagard RH, Staessen JA, Thijs L, Celis H, Bulpitt CJ, de Leeuw PW, et al. On treatment diastolic blood pressure and prognosis in systolic hypertension. Arch Intern. 2007;167:1884–91.CrossRef Fagard RH, Staessen JA, Thijs L, Celis H, Bulpitt CJ, de Leeuw PW, et al. On treatment diastolic blood pressure and prognosis in systolic hypertension. Arch Intern. 2007;167:1884–91.CrossRef
18.
Zurück zum Zitat Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age and older. N Engl J Med. 2008;358:1887–98.PubMedCrossRef Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age and older. N Engl J Med. 2008;358:1887–98.PubMedCrossRef
19.
Zurück zum Zitat JATOS Study Group. Principal results of the Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients (JATOS). Hypertens Res. 2008;31:2115–27.CrossRef JATOS Study Group. Principal results of the Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients (JATOS). Hypertens Res. 2008;31:2115–27.CrossRef
20.
Zurück zum Zitat Ogihara T, Saruta T, Raguki H, et al. Target blood pressure for treatment of isolated systolic hypertension in the elderly. Hypertension. 2010;56:196–202.PubMedCrossRef Ogihara T, Saruta T, Raguki H, et al. Target blood pressure for treatment of isolated systolic hypertension in the elderly. Hypertension. 2010;56:196–202.PubMedCrossRef
21.
Zurück zum Zitat Denardo SJ, Gong Y, Nichols WW, Messerli FH, Bavry AA, Cooper-Dehoff RM, Handberg EM, Champion A, Pepine CJ. Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST substudy. Am J Med. 2010;123:719–26.PubMedCrossRef Denardo SJ, Gong Y, Nichols WW, Messerli FH, Bavry AA, Cooper-Dehoff RM, Handberg EM, Champion A, Pepine CJ. Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST substudy. Am J Med. 2010;123:719–26.PubMedCrossRef
22.
Zurück zum Zitat Pepine CJ, Handberg EM, Cooper-DeHoff RM, et al. A calcium antagonist versus a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA. 2003;290:2805–16.PubMedCrossRef Pepine CJ, Handberg EM, Cooper-DeHoff RM, et al. A calcium antagonist versus a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA. 2003;290:2805–16.PubMedCrossRef
23.
Zurück zum Zitat Messerli FH, Mancia G, Conti CR, Hewkin AC, Kupfer S, Champion A, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med. 2006;144:884–93.PubMed Messerli FH, Mancia G, Conti CR, Hewkin AC, Kupfer S, Champion A, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med. 2006;144:884–93.PubMed
24.
Zurück zum Zitat Denardo SJ, Messerli FH, Gaxiola E, Aranda JM Jr, Cooper-Dehoff RM, Handberg EM, et al. Coronary revascularization strategy and outcomes according to blood pressure (from the International Verapamil-Trandolapril Study [INVEST]. Am J Cardiol. 2010;106:498–503.PubMedCrossRef Denardo SJ, Messerli FH, Gaxiola E, Aranda JM Jr, Cooper-Dehoff RM, Handberg EM, et al. Coronary revascularization strategy and outcomes according to blood pressure (from the International Verapamil-Trandolapril Study [INVEST]. Am J Cardiol. 2010;106:498–503.PubMedCrossRef
25.
Zurück zum Zitat Bavry AA, Anderson D, Gong Y, Denardo SJ, Cooper-DeHoff RM, Handberg EM, et al. Outcomes among hypertensive patients with concomitant peripheral and coronary artery disease: findings from the INternational VErapamil-SR/Trandolapril Study. Hypertension. 2010;55:48–53.PubMedCrossRef Bavry AA, Anderson D, Gong Y, Denardo SJ, Cooper-DeHoff RM, Handberg EM, et al. Outcomes among hypertensive patients with concomitant peripheral and coronary artery disease: findings from the INternational VErapamil-SR/Trandolapril Study. Hypertension. 2010;55:48–53.PubMedCrossRef
26.
Zurück zum Zitat LaRosa JC, Deedwania PC, Shepherd J, et al. Comparison of 80 versus 10 mg of atorvastatin on occurrence of cardiovascular events after the first event (from the Treating to New Targets [TNT] trial). Am J Cardiol. 2010;105:283–7.PubMedCrossRef LaRosa JC, Deedwania PC, Shepherd J, et al. Comparison of 80 versus 10 mg of atorvastatin on occurrence of cardiovascular events after the first event (from the Treating to New Targets [TNT] trial). Am J Cardiol. 2010;105:283–7.PubMedCrossRef
27.
Zurück zum Zitat Bangalore S, Messerli FH, Wun C, et al. J-curve revisited: an analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) Trial. Eur Hear J. 2010;31:2897–908.CrossRef Bangalore S, Messerli FH, Wun C, et al. J-curve revisited: an analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) Trial. Eur Hear J. 2010;31:2897–908.CrossRef
28.
Zurück zum Zitat Gerstein HC, Miller ME, Byington RP, et al. On behalf of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545–59.PubMedCrossRef Gerstein HC, Miller ME, Byington RP, et al. On behalf of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545–59.PubMedCrossRef
29.
Zurück zum Zitat ACCORD Study Group. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med. 2010;362:1563–74.CrossRef ACCORD Study Group. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med. 2010;362:1563–74.CrossRef
30.
Zurück zum Zitat •• ACCORD Study Group, Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575–85. This large randomized controlled trial demonstrated for the first time no benefit of aggressive antihypertensive treatment to a goal SBP<120 mm Hg compared with conventional treatment to a goal SBP<140 mm Hg on CVD outcomes other than stroke in patients with hypertension and diabetes..PubMedCrossRef •• ACCORD Study Group, Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575–85. This large randomized controlled trial demonstrated for the first time no benefit of aggressive antihypertensive treatment to a goal SBP<120 mm Hg compared with conventional treatment to a goal SBP<140 mm Hg on CVD outcomes other than stroke in patients with hypertension and diabetes..PubMedCrossRef
31.
Zurück zum Zitat Rationale and design of the ADVANCE study: a randomised trial of blood pressure lowering and intensive glucose control in high-risk individuals with type 2 diabetes mellitus. Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation. J Hypertens Suppl. 2001;19(Suppl):S21–8. Rationale and design of the ADVANCE study: a randomised trial of blood pressure lowering and intensive glucose control in high-risk individuals with type 2 diabetes mellitus. Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation. J Hypertens Suppl. 2001;19(Suppl):S21–8.
32.
Zurück zum Zitat Patel A, MacMahon S, Chalmers J, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): A randomised controlled trial. Lancet. 2007;370:829–40.PubMedCrossRef Patel A, MacMahon S, Chalmers J, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): A randomised controlled trial. Lancet. 2007;370:829–40.PubMedCrossRef
33.
Zurück zum Zitat de Galan BE, Perkovic V, Ninomiya T, Pillai A, Patel A, Cass A, et al. ADVANCE Collaborative Group. Lowering blood pressure reduces renal events in type 2 diabetes. J Am Soc Nephrol. 2009;20:883–92.PubMedCrossRef de Galan BE, Perkovic V, Ninomiya T, Pillai A, Patel A, Cass A, et al. ADVANCE Collaborative Group. Lowering blood pressure reduces renal events in type 2 diabetes. J Am Soc Nephrol. 2009;20:883–92.PubMedCrossRef
34.
Zurück zum Zitat •• Cooper-DeHoff RM, Gong Y, Handberg EM, Bavry AA, Denardo SJ, Bakris GL, et al. Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease. JAMA. 2010;304:61–8. This subgroup analysis of data from INVEST demonstrated no benefit of tight SBP control (<130 mm Hg) compared with conventional SBP control (<140 mm Hg) on CVD outcomes or all-cause mortality..PubMedCrossRef •• Cooper-DeHoff RM, Gong Y, Handberg EM, Bavry AA, Denardo SJ, Bakris GL, et al. Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease. JAMA. 2010;304:61–8. This subgroup analysis of data from INVEST demonstrated no benefit of tight SBP control (<130 mm Hg) compared with conventional SBP control (<140 mm Hg) on CVD outcomes or all-cause mortality..PubMedCrossRef
35.
Zurück zum Zitat Wright Jr JT, Bakris G, Greene T, et al. African American Study of Kidney Disease and Hypertension Study Group. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. 2002;288:2421–31.PubMedCrossRef Wright Jr JT, Bakris G, Greene T, et al. African American Study of Kidney Disease and Hypertension Study Group. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. 2002;288:2421–31.PubMedCrossRef
36.
Zurück zum Zitat • Norris K, Bourgoigne J, Gassman J, Hebert L, et al. Cardiovascular outcomes in the African American Study of Kidney Disease and Hypertension AASK (Trial). Am J Kidney Dis. 2006;48:739–51. This analysis of CVD outcomes during the active phase of AASK showed no benefit of either intensive antihypertensive treatment or of any particular antihypertensive drug class..PubMedCrossRef • Norris K, Bourgoigne J, Gassman J, Hebert L, et al. Cardiovascular outcomes in the African American Study of Kidney Disease and Hypertension AASK (Trial). Am J Kidney Dis. 2006;48:739–51. This analysis of CVD outcomes during the active phase of AASK showed no benefit of either intensive antihypertensive treatment or of any particular antihypertensive drug class..PubMedCrossRef
37.
Zurück zum Zitat • Appel LJ, Wright JT, Greene T, et al. Intensive blood pressure control in hypertensive chronic kidney disease. N Engl J Med. 2010;363:918–29. Long-term followup of AASK showed no benefit of intensive BP control on either progression of CKD or mortality in the absence of proteinuria..PubMedCrossRef • Appel LJ, Wright JT, Greene T, et al. Intensive blood pressure control in hypertensive chronic kidney disease. N Engl J Med. 2010;363:918–29. Long-term followup of AASK showed no benefit of intensive BP control on either progression of CKD or mortality in the absence of proteinuria..PubMedCrossRef
38.
Zurück zum Zitat Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345:851–60.PubMedCrossRef Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345:851–60.PubMedCrossRef
39.
Zurück zum Zitat Berl T, Hunsicker LG, Lewis JB, et al. Collaborative Study Group. Impact of achieved blood pressure on cardiovascular outcomes in the Irbesartan Diabetic Nephropathy Trial. J Am Soc Nephrol. 2005;16:2170–9.PubMedCrossRef Berl T, Hunsicker LG, Lewis JB, et al. Collaborative Study Group. Impact of achieved blood pressure on cardiovascular outcomes in the Irbesartan Diabetic Nephropathy Trial. J Am Soc Nephrol. 2005;16:2170–9.PubMedCrossRef
40.
Zurück zum Zitat Dahlöf B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002;359:995–1003.PubMedCrossRef Dahlöf B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002;359:995–1003.PubMedCrossRef
41.
Zurück zum Zitat • Okin PM, Hille DA, Kjeldsen SE, Dahlöf B, Devereux RB. Impact of lower achieved blood pressure on outcomes in hypertensive patients. J Hypertens. 2012;30:802–10. Post-hoc analysis of LIFE showed for the first time that lowering SBP to ≤130 mm Hg had no benefit on CVD outcomes or stroke and increased all-cause mortality in patients with ECG-LVH. • Okin PM, Hille DA, Kjeldsen SE, Dahlöf B, Devereux RB. Impact of lower achieved blood pressure on outcomes in hypertensive patients. J Hypertens. 2012;30:802–10. Post-hoc analysis of LIFE showed for the first time that lowering SBP to ≤130 mm Hg had no benefit on CVD outcomes or stroke and increased all-cause mortality in patients with ECG-LVH.
42.
Zurück zum Zitat Julius S, Kjeldsen SE, Weber M, et al. Outcomes in hypertensive patients at high vascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomized trial. Lancet. 2004;363:2022–31.PubMedCrossRef Julius S, Kjeldsen SE, Weber M, et al. Outcomes in hypertensive patients at high vascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomized trial. Lancet. 2004;363:2022–31.PubMedCrossRef
43.
Zurück zum Zitat Messerli FH, Mancia G, Weber MA, Kjeldsen SE, Holzhauer B, Hua TA, et al. Low blood pressure is associated with increased cardiovascular morbidity (J-shaped curve) in treated hypertensive patients with increased cardiovascular risk: The VALUE Randomized Trial. J Am Coll Cardiol. 2009;53(Suppl A):A46. Messerli FH, Mancia G, Weber MA, Kjeldsen SE, Holzhauer B, Hua TA, et al. Low blood pressure is associated with increased cardiovascular morbidity (J-shaped curve) in treated hypertensive patients with increased cardiovascular risk: The VALUE Randomized Trial. J Am Coll Cardiol. 2009;53(Suppl A):A46.
44.
Zurück zum Zitat Zanchetti A, Julius S, Kjeldsen S, McInnes GT, Hua T, Weber M, et al. Outcomes in subgroups of hypertensive patients treated with regimens based on valsartan and amlodipine: an analysis of findings from the VALUE trial. J Hypertens. 2006;24:2163–8.PubMedCrossRef Zanchetti A, Julius S, Kjeldsen S, McInnes GT, Hua T, Weber M, et al. Outcomes in subgroups of hypertensive patients treated with regimens based on valsartan and amlodipine: an analysis of findings from the VALUE trial. J Hypertens. 2006;24:2163–8.PubMedCrossRef
45.
Zurück zum Zitat Verdecchia P, Staessen J, Angeli F, et al. Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-sis): an open-label randomized trial. Lancet. 2009;374:525–33.PubMedCrossRef Verdecchia P, Staessen J, Angeli F, et al. Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-sis): an open-label randomized trial. Lancet. 2009;374:525–33.PubMedCrossRef
46.
Zurück zum Zitat ONTARGET Investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358:1547–59. ONTARGET Investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358:1547–59.
47.
Zurück zum Zitat •• Sleight P, Redon J, Verdecchia P, et al. Prognostic value of blood pressure in patients with high vascular risk in the Ongoing Telmisartan alone and in combination with Ramipril Global Endpoint Trial study. J Hypertens. 2009;27:13609. This post-hoc analysis of ONTARGET showed no benefit on fatal or nonfatal CVD outcomes from reducing SBP to ≤130 mm Hg. •• Sleight P, Redon J, Verdecchia P, et al. Prognostic value of blood pressure in patients with high vascular risk in the Ongoing Telmisartan alone and in combination with Ramipril Global Endpoint Trial study. J Hypertens. 2009;27:13609. This post-hoc analysis of ONTARGET showed no benefit on fatal or nonfatal CVD outcomes from reducing SBP to ≤130 mm Hg.
48.
Zurück zum Zitat Redon J, Mancia G, Sleight P, et al. Safety and efficacy of low blood pressures among patients with diabetes: subgroup analyses from the ONTARGET trial. J Am Coll Cardiol. 2012;59:74–83.PubMedCrossRef Redon J, Mancia G, Sleight P, et al. Safety and efficacy of low blood pressures among patients with diabetes: subgroup analyses from the ONTARGET trial. J Am Coll Cardiol. 2012;59:74–83.PubMedCrossRef
49.
Zurück zum Zitat Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375:2215–22.PubMedCrossRef Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375:2215–22.PubMedCrossRef
50.
Zurück zum Zitat • Mancia G, Schumacher H, Redon J, Verdecchia P, Schmieder R, Jennings G, et al. Blood pressure targets recommmended by guidelines and incidence of cardiovascular and renal events in ONTARGET. Circulation. 2011;124:1727–36. A secondary analysis of ONTARGET demonstrated that in high-CVD risk patients reducing BP to <140/90 mm Hg, but not to a lower BP, is associated with CVD protection; achievement of lower goals may be useful in preventing stroke and renal outcomes..PubMedCrossRef • Mancia G, Schumacher H, Redon J, Verdecchia P, Schmieder R, Jennings G, et al. Blood pressure targets recommmended by guidelines and incidence of cardiovascular and renal events in ONTARGET. Circulation. 2011;124:1727–36. A secondary analysis of ONTARGET demonstrated that in high-CVD risk patients reducing BP to <140/90 mm Hg, but not to a lower BP, is associated with CVD protection; achievement of lower goals may be useful in preventing stroke and renal outcomes..PubMedCrossRef
51.
Zurück zum Zitat Simons PC, Algra A, van de Laak MF, Grobbee DE, van der Graaf Y. Second manifestations of ARTerial disease (SMART) study: rationale and design. Eur J Epidemiol. 1999;15:773–81.PubMedCrossRef Simons PC, Algra A, van de Laak MF, Grobbee DE, van der Graaf Y. Second manifestations of ARTerial disease (SMART) study: rationale and design. Eur J Epidemiol. 1999;15:773–81.PubMedCrossRef
52.
Zurück zum Zitat • Dorresteijn JA, van der Graaf Y, Spiering W, et al. Secondary Manifestations of Arterial Disease Study Group. Relation between blood pressure and vascular events and mortality in patients with manifest vascular disease: J-curve revisited. Hypertension. 2012;59:14–21. This large cohort study of patients with symptomatic vascular disease at baseline demonstrated a J-curve with a nadir of 143/82 mm Hg for all vascular events except stroke.PubMedCrossRef • Dorresteijn JA, van der Graaf Y, Spiering W, et al. Secondary Manifestations of Arterial Disease Study Group. Relation between blood pressure and vascular events and mortality in patients with manifest vascular disease: J-curve revisited. Hypertension. 2012;59:14–21. This large cohort study of patients with symptomatic vascular disease at baseline demonstrated a J-curve with a nadir of 143/82 mm Hg for all vascular events except stroke.PubMedCrossRef
53.
Zurück zum Zitat Panjrath GS, Chaudhari S, Messerli FH. The j-point phenomenon in aggressive therapy of hypertension: new insights. Curr Atherosclerosis Rep. 2012;14:124–9.CrossRef Panjrath GS, Chaudhari S, Messerli FH. The j-point phenomenon in aggressive therapy of hypertension: new insights. Curr Atherosclerosis Rep. 2012;14:124–9.CrossRef
Metadaten
Titel
J Curve in Hypertension
verfasst von
Tanja Dudenbostel
Suzanne Oparil
Publikationsdatum
01.08.2012
Verlag
Current Science Inc.
Erschienen in
Current Cardiovascular Risk Reports / Ausgabe 4/2012
Print ISSN: 1932-9520
Elektronische ISSN: 1932-9563
DOI
https://doi.org/10.1007/s12170-012-0246-0

Weitere Artikel der Ausgabe 4/2012

Current Cardiovascular Risk Reports 4/2012 Zur Ausgabe

Physical Activity (Der Warburton, Section Editor)

The Exercising Commuter: Is Commuting a Healthy Way to Be Active?

Die „Zehn Gebote“ des Endokarditis-Managements

30.04.2024 Endokarditis Leitlinie kompakt

Worauf kommt es beim Management von Personen mit infektiöser Endokarditis an? Eine Kardiologin und ein Kardiologe fassen die zehn wichtigsten Punkte der neuen ESC-Leitlinie zusammen.

Strenge Blutdruckeinstellung lohnt auch im Alter noch

30.04.2024 Arterielle Hypertonie Nachrichten

Ältere Frauen, die von chronischen Erkrankungen weitgehend verschont sind, haben offenbar die besten Chancen, ihren 90. Geburtstag zu erleben, wenn ihr systolischer Blutdruck < 130 mmHg liegt. Das scheint selbst für 80-Jährige noch zu gelten.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Dihydropyridin-Kalziumantagonisten können auf die Nieren gehen

30.04.2024 Hypertonie Nachrichten

Im Vergleich zu anderen Blutdrucksenkern sind Kalziumantagonisten vom Diyhdropyridin-Typ mit einem erhöhten Risiko für eine Mikroalbuminurie und in Abwesenheit eines RAS-Blockers auch für ein terminales Nierenversagen verbunden.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.