Messerli Franz H, Panjrath Gurusher S
Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, New York 10019, USA.
J Am Coll Cardiol. 2009 Nov 10;54(20):1827-34. doi: 10.1016/j.jacc.2009.05.073.
The topic of the J-curve relationship between blood pressure and coronary artery disease (CAD) has been the subject of much controversy for the past decades. An inverse relationship between diastolic pressure and adverse cardiac ischemic events (i.e., the lower the diastolic pressure the greater the risk of coronary heart disease and adverse outcomes) has been observed in numerous studies. This effect is even more pronounced in patients with underlying CAD. Indeed, a J-shaped relationship between diastolic pressure and coronary events was documented in treated patients with CAD in most large trials that scrutinized this relationship. In contrast to any other vascular bed, the coronary circulation receives its perfusion mostly during diastole; hence, an excessive decrease in diastolic pressure can significantly hamper perfusion. This adverse effect of too low a diastolic pressure on coronary heart disease leaves the practicing physician with the disturbing possibility that, in patients at risk, lowering blood pressure to levels that prevent stroke or renal disease might actually precipitate myocardial ischemia. However, these concerns should not deter physicians from pursuing a more aggressive control of hypertension, because currently blood pressure is brought to recommended target levels in only approximately one-third of patients.
在过去几十年里，血压与冠状动脉疾病（CAD）之间的J曲线关系一直是备受争议的话题。众多研究观察到舒张压与不良心脏缺血事件之间存在负相关关系（即舒张压越低，冠心病和不良后果的风险越高）。这种效应在患有潜在CAD的患者中更为明显。事实上，在大多数仔细研究这种关系的大型试验中，已记录到接受治疗的CAD患者舒张压与冠状动脉事件之间呈J形关系。与其他任何血管床不同，冠状动脉循环主要在舒张期接受灌注；因此，舒张压过度降低会显著妨碍灌注。舒张压过低对冠心病的这种不利影响让执业医生担心，在有风险的患者中，将血压降至预防中风或肾病的水平实际上可能会引发心肌缺血。然而，这些担忧不应阻止医生更积极地控制高血压，因为目前只有大约三分之一的患者血压能达到推荐的目标水平。
