Fuchs F D, Fuchs S C
National Institute of Science and Technology for Health Technology Assessment (IATS)-CNPq, Hospital de Clinicas de Porto Alegre, UFRGS, Porto Alegre, Brazil.
J Hum Hypertens. 2014 Feb;28(2):80-4. doi: 10.1038/jhh.2013.78. Epub 2013 Aug 22.
The risk that lowering blood pressure (BP) excessively increases the incidence of cardiovascular disease-the J-shaped phenomenon-has been a matter of concern endorsed by many experts, particularly in patients with coronary heart disease and diabetes. The results of the Action to Control Cardiovascular Risk in Type 2 Diabetes (ACCORD) trial strengthened the idea that it may be futile to lower BP more intensively in patients with diabetes. Nevertheless, there seems to be no direct J-shaped relation between BP-lowering treatment and outcome. Patients with normal or low BP and high or very high cardiovascular risk could have their BP reduced further by treatment. Placebo-controlled clinical trials of BP-lowering agents in patients with BP within normal values and concomitant cardiovascular disease demonstrated consistent reduction of recurrent and newer cardiovascular events. The use of BP agents in such conditions, as in patients with coronary artery disease, heart failure, diabetes and in patients recovered from a stroke has been endorsed by guidelines. Although is likely that there is a J-shaped relationship of BP with outcomes in cohort studies, clinical trials that tested more intensive versus standard goals and clinical trials done with patients with low BP demonstrated that the J-shaped phenomenon should not be a concern in the treatment of high BP.
过度降低血压（BP）会增加心血管疾病发病率的风险——即J形现象——一直是许多专家关注的问题，尤其是在冠心病和糖尿病患者中。控制2型糖尿病患者心血管风险行动（ACCORD）试验的结果强化了这样一种观点，即对糖尿病患者更强化地降低血压可能是徒劳的。然而，降压治疗与预后之间似乎不存在直接的J形关系。血压正常或偏低且心血管风险高或非常高的患者可以通过治疗进一步降低血压。对血压正常且伴有心血管疾病的患者进行的降压药物安慰剂对照临床试验表明，复发性和新发心血管事件持续减少。在这种情况下使用降压药物，如在冠心病、心力衰竭、糖尿病患者以及中风康复患者中使用，已得到指南认可。尽管在队列研究中血压与预后可能存在J形关系，但比较强化目标与标准目标的临床试验以及针对低血压患者进行的临床试验表明，在高血压治疗中不应担心J形现象。
