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(Hypertension. 1997;29:537-538.)
© 1997 American Heart Association, Inc.

Articles

Blood Pressure Lowering for the Secondary Prevention of Myocardial Infarction and Stroke

Stephen MacMahon; Anthony Rodgers; Bruce Neal; John Chalmers

the Clinical Trials Research Unit, Department of Medicine, The University of Auckland (New Zealand) (S.M., A.R., B.N.), and the Research Office, Royal North Shore Hospital, University of Sydney (Australia) (J.C.).

Key Words: myocardial infarction • cerebrovascular disorders • blood pressure • antihypertensive agents • Editorial

	Introduction

 
Blood pressure (BP) levels are directly and continuously associated with the risks of both coronary heart disease and stroke in individuals without a history of major cardiovascular disease,¹ and randomized trials in patients with hypertension have demonstrated that BP lowering reduces these risks after just a few years of beginning treatment.^{2 3} The proportional benefits of treatment appear to be similar in higher and lower risk patients, and the absolute benefits therefore increase with the level of absolute risk.³ This raises the possibility that patients at highest absolute risk of myocardial infarction or stroke, namely, those with established coronary or cerebrovascular disease, stand to benefit most from BP lowering.

However, questions about the safety of BP reduction for patients with preexisting cardiovascular disease have been raised following observations of J- and U-shaped associations between BP levels and the risks of recurrent myocardial infarction⁴ and stroke.⁵ Until recently, it has been unclear whether the J- and U-shaped associations resulted from low BP causing an increase in recurrent events or from more severe or unstable disease causing a decrease in BP and, independently, an increased risk of recurrence. If the latter were true, it could be hypothesized that the nonlinear associations would be most marked in the first few years of follow-up, when those individuals with the most severe or unstable disease would be at particular risk of recurrence. Additionally, it could be hypothesized that these associations would be less apparent or absent among individuals with less severe, more stable disease.

Two recent . . . [Full Text of this Article]

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