Isles C G, Hole D J
Department of Medicine, Dumfries and Galloway Royal Infirmary.
Clin Exp Hypertens A. 1992;14(1-2):139-49. doi: 10.3109/10641969209036177.
The question whether there is a level of diastolic pressure during treatment below which further reduction of pressure may be harmful rather than beneficial is of great interest. If, as the proponents of this hypothesis maintain, death from CHD among treated hypertensives becomes more rather than less common at very low diastolic pressure, this might explain at least in part why most primary prevention trials of hypertension have failed to show a reduction in CHD mortality. However, as the sceptics have pointed out, the evidence that drug induced lowering of blood pressure is harmful is not of the highest quality, and alternative explanations for excess cardiovascular mortality at low diastolic pressure exist. In the following review of this hotly contested debate it is concluded that both proponents and sceptics may be correct, but that the presence of a J curve should not divert attention from the main benefit of treating hypertension which is a reduction in the risk of fatal and non fatal stroke.
治疗期间是否存在一个舒张压水平，低于该水平进一步降低血压可能有害而非有益，这一问题备受关注。如果正如该假说的支持者所主张的那样，在舒张压非常低时，接受治疗的高血压患者中死于冠心病的情况变得更加常见而非少见，那么这至少可以部分解释为什么大多数高血压一级预防试验未能显示冠心病死亡率降低。然而，正如怀疑者所指出的，药物诱导的血压降低有害这一证据并非质量最高的，而且对于低舒张压时心血管死亡率过高存在其他解释。在对这场激烈争论的以下综述中得出的结论是，支持者和怀疑者可能都正确，但J曲线的存在不应转移对治疗高血压的主要益处（即降低致命性和非致命性中风风险）的关注。
