Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland.
Curr Hypertens Rep. 2012 Dec;14(6):556-66. doi: 10.1007/s11906-012-0314-3.
The blood pressure (BP) J-curve debate started in 1979, and we still cannot definitively answer all the questions. However, available studies of antihypertensive treatment provide strong evidence for J-shaped relationships between both diastolic and systolic BP and main outcomes in the general population of hypertensive patients, as well as in high-risk populations, including subjects with coronary artery disease, diabetes mellitus, left ventricular hypertrophy, and elderly patients. However, further studies are still necessary in order to clarify this issue. This is connected to the fact that most available studies were observational, and randomized trials did not have or lost their statistical power and were inconclusive. Perhaps only the Systolic Blood Pressure Intervention Trial (SPRINT) and Optimal Blood Pressure and Cholesterol Targets for Preventing Recurrent Stroke in Hypertensives (ESH-CHL-SHOT) will be able to finally answer all the questions. According to the current state of knowledge, it seems reasonable to suggest lowering BP to values within the 130-139/80-85 mmHg range, possibly close to the lower values in this range, in all hypertensive patients and to be very careful with further BP level reductions, especially in high-risk hypertensive patients.
血压“J 型曲线”的争论始于 1979 年，我们仍然无法明确回答所有问题。然而，现有的降压治疗研究为高血压患者一般人群以及高危人群（包括冠心病、糖尿病、左心室肥厚和老年患者）的舒张压和收缩压与主要结局之间的 J 型关系提供了强有力的证据。然而，为了澄清这一问题，仍有必要进行进一步的研究。这与大多数现有研究都是观察性研究有关，随机试验没有或失去了统计学效力，结果也不确定。也许只有收缩压干预试验（SPRINT）和预防高血压患者复发性卒中的最佳血压和胆固醇目标研究（ESH-CHL-SHOT）才能最终回答所有问题。根据目前的知识状况，建议将所有高血压患者的血压降低到 130-139/80-85mmHg 范围内的值，可能接近该范围内的较低值，并非常谨慎地进一步降低血压水平，尤其是在高危高血压患者中，这似乎是合理的。
