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(Hypertension. 1999;34:1179.)
© 1999 American Heart Association, Inc.

Editorial Commentary

Reappearance of the J-Shaped Curve

Edward D. Frohlich

From the Alton Ochsner Medical Foundation, New Orleans, La.

Correspondence to Edward D. Frohlich, MD, Editor-in-Chief, Hypertension, Alton Ochsner Medical Foundation, 1516 Jefferson Hwy, BH-514, New Orleans, LA 70121.

Key Words: Editorial • myocardial infarction • blood pressure

	Introduction

 
So soon after we believed that the issue had been resolved concerning the existence of a J-shaped curve relationship between myocardial infarction mortality and the level of blood pressure associated with antihypertensive therapy, this "curve" phenomenon has reappeared. The relationship was said to exist when a higher mortality rate from myocardial infarction was found in hypertensive patients with diastolic pressures <85 mm Hg which appeared to be greater than in those patients whose diastolic pressures were between 85 and 90 mm Hg. The steeper and higher aspect of the J-curve was demonstrated when pretreatment pressures exceeded 90 mm Hg.¹ This report was confirmed by subsequent retrospective analyses.^{2 3} However, the issue seemed to have been resolved until several reports appeared indicating that hypertensive or normotensive patients who were elderly or who had ischemic heart disease failed to demonstrate such a J-shaped curve with treatment even if diastolic pressure was <90 mm Hg.^{4 5 6 7}

In this issue of the journal, Voko et al⁸ once again revisit the subject by reporting that a J-curve relationship between stroke incidence and treatment of hypertension exists. In their paper, they demonstrated an increased risk of stroke in treated hypertensive patients having the lowest systolic and, more significantly, diastolic pressure elevations not seen in those patients who were untreated. To be sure, as might be expected, the issue is not totally clear and straightforward. Thus, the authors found that spontaneously occurring low arterial pressures are indeed beneficial, but in those patients who were treated and whose pressure was . . . [Full Text of this Article]

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