Aggressive Blood Pressure Lowering Is Dangerous: The J-Curve Pro Side of the Argument

摘要: Historically, the possibility that reducing blood pressure (BP) might have harmful effects has gone through 3 temporal steps. In first half of last century, it was a widespread belief an elevated BP provided necessary hydraulic gradient to preserve organ perfusion in face increase systemic vascular resistance, implication being hypertension compensatory mechanism and no BP-lowering intervention justified.1 This largely forgotten subsequent 2 decades where results antihypertensive treatment trials dominated scene emphasized beneficial reductions at most if not all degrees elevation.2–6 The produce harm rather than benefit resurfaced late 70s 80s,7,8 however, due particular report patients with high cardiovascular risk incidence myocardial infarction diminished by diastolic 85 90 mm Hg but increased when more pronounced reduction occurred.8 Despite its important limitations (small number patients, few cardiac events, retrospective nature observations), widely referred revived popularity since characterized J-curve phenomenon, is, possible J-shaped linear relationship incident events. The present article will argue favor this hypothesis. It be acknowledged is supported undisputable evidence such as randomized trials. emphasized, hypothesis common sense, physiological data, from large-scale observational studies, often derived on individuals or very risk. makes just …