The J-curve. The importance of gradual reduction of blood pressure.

Even if the treatment goal in hypertension is 'the lower the better', it is obvious that blood pressure (BP) cannot be reduced without reaching a point at which organ perfusion may become compromised and where mortality and morbidity will increase rather than decrease. In 1979, a 5-fold increase in myocardial infarction among patients whose diastolic BP was reduced to below 95mm Hg was reported. In 1987, these results were confirmed, and a J-shaped relationship between diastolic BP and death from myocardial infarction in those patients with evidence of ischaemic heart disease at entry into the trial was shown. In recent years, several studies have demonstrated this J-shaped curve with a J-point between 85 and 91mm Hg. However, all the data were obtained in retrospective analyses of a small number of patients and prospective properly designed studies are necessary before changing our treatment criteria. The Behandla Blodtryck Battre Study fulfils these criteria and preliminary results demonstrate that it is possible to achieve a further reduction in BP in well controlled hypertensive patients without increasing the incidence of side effects.