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

Submitted: 7 December 2012
Accepted: 7 December 2012
Published: 10 December 2012
Abstract Views: 1024
PDF: 727
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

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.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

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