Aggressive blood pressure reduction in patients at high vascular risk: is it dangerous?

  • Fabio Angeli | paola.granata@pagepress.org
  • Gianpaolo Reboldi
  • Cristina Poltronieri
  • Giovanni Mazzotta
  • Marta Garofoli
  • Elisa Ramundo
  • Alessandra Biadetti
  • Paolo Verdecchia

Abstract

Introduction The aim of this review was to summarize the current state of evidence regarding the optimal blood pressure goals in patients with high vascular risk. In particular, this review critically addresses the issue of the “J-curve” paradox – a hypothesis indicating that low treatment-induced blood pressure values are characterized by an increase, rather than a decrease, in the incidence of cardiovascular events. Materials and methods We reviewed evidence from studies published in peer-reviewed journals indexed in Medline, EMBASE and CINAHL that compared different BP goals. Results Post-hoc analyses of randomized trials specifically conducted to test the hypothesis of the “J-shaped curve” yielded conflicting results. However, trials directly comparing different blood pressure goals and meta-analyses showed that in-treatment blood pressure values below the usual goal of less than 140/90 mmHg improve outcomes in patients at increased vascular risk. Discussion The fear that an excessive reduction in blood pressure may be dangerous is inconsistent with the available data and probably conditioned by the adverse impact of other risk factors that may be more frequent in patients with low values of achieved blood pressure. The association between blood pressure reduction and cardiovascular risk seems to be linear and not J-shaped.

Downloads

Download data is not yet available.
Published
2012-12-10
Section
Reviews
Keywords:
J-curve, Blood pressure goals, Hypertension, Treatment, Cardiovascular risk
Statistics
Abstract views: 773

PDF: 491
Share it

PlumX Metrics

PlumX Metrics provide insights into the ways people interact with individual pieces of research output (articles, conference proceedings, book chapters, and many more) in the online environment. Examples include, when research is mentioned in the news or is tweeted about. Collectively known as PlumX Metrics, these metrics are divided into five categories to help make sense of the huge amounts of data involved and to enable analysis by comparing like with like.

How to Cite
Angeli, F., Reboldi, G., Poltronieri, C., Mazzotta, G., Garofoli, M., Ramundo, E., Biadetti, A., & Verdecchia, P. (2012). Aggressive blood pressure reduction in patients at high vascular risk: is it dangerous?. Italian Journal of Medicine, 6(4), 302–306. https://doi.org/10.4081/itjm.2012.302