Korean Circ J.  2011 Jul;41(7):349-353. 10.4070/kcj.2011.41.7.349.

The Significance of the J-Curve in Hypertension and Coronary Artery Diseases

• Park CG
• Lee JY

• KMID: 2225096
• DOI: http://doi.org/10.4070/kcj.2011.41.7.349

Abstract

The J-curve effect describes an inverse relation between low blood pressure (BP) and cardiovascular complications. This effect is more pronounced in patients with preexisting coronary artery disease (CAD), hypertension or left ventricular hypertrophy (LVH). The recent large clinical outcomes trials have observed a J-curve effect between a diastolic BP of 70-80 mmHg as well as a systolic BP <130 mmHg. The J-curve phenomenon does not appear in stroke or renal disease. This is because the coronary arteries are perfused during diastole, but the cerebral and renal perfusion mainly occurs in systole. Therefore, caution should be taken to maintain the diastolic blood pressure (DBP) at minimum of 70 mmHg and possibly to maintain the DBP between 80-85 mmHg in patients with severe LVH, CAD or vascular diseases. BP control in high-risk elderly patients should be carefully done as undergoing aggressive therapy to lower the systolic blood pressure below 140 mmHg can cause cardiovascular complications due to the severely reduced DBP and increased pulse pressure.

Keyword

Hypertension; J-curve; Coronary artery disease; Diastolic pressure; Systolic pressure; Stroke

MeSH Terms

Aged
Blood Pressure
Coronary Artery Disease
Coronary Vessels
Diastole
Humans
Hypertension
Hypertrophy, Left Ventricular
Hypotension
Perfusion
Stroke
Systole
Vascular Diseases

Figure

• 

  Fig. 1 The Incidence of the myocardial infarction and stroke as stratified by diastolic blood pressure in the International Verapamil SR-Trandolapril study.18)

• 

  Fig. 2 Interaction of the J-Curve with coronary revascularization. The patients who were revascularized better tolerated a lower diastolic blood pressure (DBP) than those who were not.18)

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  Fig. 3 Results of the peoprotion of events in Action to Control Cardiovascular Risk in Diabetes-blood pressure (effects of intensive blood-pressure control in type 2 diabetes mellitus) (A) and the Adjusted risk of all-cause mortality in International Verapamil SR-Trandolapril (B).23)

• 

  Fig. 4 The pre- and post-treatment systolic blood pressure clinical benefit in a clinical hypertension study on diabetic patients.18)

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