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J-Curve During Hypertension Control: Rationale for Not Lowering the Diastolic Pressure Below 85 mm Hg

J-Curve During Hypertension Control: Rationale for Not Lowering the Diastolic Pressure Below 85... Abstract To the Editor. — Overenthusiastic reduction of diastolic blood pressure in the treatment of essential hypertension could be detrimental. Cruickshank et al1 reported a rise in the incidence of myocardial infarction in hypertensive patients when the diastolic pressure had been maintained below 85 mm Hg. Such an upward trend in the myocardial infarction events among the "well"-treated hypertensive individuals gave a Jshape appearance to the mortality curve. Alderman et al2 found that those with diastolic pressure reduction between 7 and 17 mm Hg from an average of 102 mm Hg had a myocardial infarction rate of 0.9%, but if the reduction was lesser or greater than that range the infarction rates were 3.1% and 3.7%, respectively. This supports the observation by Cruickshank et al of 85 mm Hg as the lowest beneficial diastolic blood pressure reduction level (102 — 17 = 85). Subendocardial ischemia may result from a significant References 1. Cruickshank JM, Thorp JM, Zacharias FJ. Benefits and potential harm of lowering high blood pressure . Lancet . 1987;1:581-584.Crossref 2. Alderman MH, Ooi WL, Madhavan S, Cohen H. Treatment-induced blood pressure reduction and the risk of myocardial infarction . JAMA . 1989;262:920-924.Crossref 3. Floras JS. Antihypertensive treatment, myocardial infarction, and nocturnal myocardial ischemia . Lancet . 1988;2:994-996.Crossref 4. Vardan S, Mookherjee S, Warner R, Smulyan H. Systolic hypertension: direct and indirect blood pressure measurements . Arch Intern Med . 1983;143:935-938.Crossref 5. Vardan S, Smulyan H, Mookherjee S. Importance of intra-arterial blood pressure measurement in the evaluation of new hypertensive agents and the need to define essential hypertension by this method . Am J Hypertens . 1990;3:901-902.Crossref 6. Moser P, Ross J, McFate PJ, Shaw RF. Control of coronary blood flow by auto regulatory mechanism . Circ Res . 1964;14:250.Crossref 7. Society of Actuaries. Build and Blood Pressure Study . Chicago, Ill: Society of Actuaries; 1959. 8. Smith HJ, Kent KM, Epstein SE. Relationship between regional contractile function and S-T segment elevation after experimental coronary artery preclusion in the dogs . Cardiovasc Res . 1978;12:444.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

J-Curve During Hypertension Control: Rationale for Not Lowering the Diastolic Pressure Below 85 mm Hg

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References (8)

Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400080154041
Publisher site
See Article on Publisher Site

Abstract

Abstract To the Editor. — Overenthusiastic reduction of diastolic blood pressure in the treatment of essential hypertension could be detrimental. Cruickshank et al1 reported a rise in the incidence of myocardial infarction in hypertensive patients when the diastolic pressure had been maintained below 85 mm Hg. Such an upward trend in the myocardial infarction events among the "well"-treated hypertensive individuals gave a Jshape appearance to the mortality curve. Alderman et al2 found that those with diastolic pressure reduction between 7 and 17 mm Hg from an average of 102 mm Hg had a myocardial infarction rate of 0.9%, but if the reduction was lesser or greater than that range the infarction rates were 3.1% and 3.7%, respectively. This supports the observation by Cruickshank et al of 85 mm Hg as the lowest beneficial diastolic blood pressure reduction level (102 — 17 = 85). Subendocardial ischemia may result from a significant References 1. Cruickshank JM, Thorp JM, Zacharias FJ. Benefits and potential harm of lowering high blood pressure . Lancet . 1987;1:581-584.Crossref 2. Alderman MH, Ooi WL, Madhavan S, Cohen H. Treatment-induced blood pressure reduction and the risk of myocardial infarction . JAMA . 1989;262:920-924.Crossref 3. Floras JS. Antihypertensive treatment, myocardial infarction, and nocturnal myocardial ischemia . Lancet . 1988;2:994-996.Crossref 4. Vardan S, Mookherjee S, Warner R, Smulyan H. Systolic hypertension: direct and indirect blood pressure measurements . Arch Intern Med . 1983;143:935-938.Crossref 5. Vardan S, Smulyan H, Mookherjee S. Importance of intra-arterial blood pressure measurement in the evaluation of new hypertensive agents and the need to define essential hypertension by this method . Am J Hypertens . 1990;3:901-902.Crossref 6. Moser P, Ross J, McFate PJ, Shaw RF. Control of coronary blood flow by auto regulatory mechanism . Circ Res . 1964;14:250.Crossref 7. Society of Actuaries. Build and Blood Pressure Study . Chicago, Ill: Society of Actuaries; 1959. 8. Smith HJ, Kent KM, Epstein SE. Relationship between regional contractile function and S-T segment elevation after experimental coronary artery preclusion in the dogs . Cardiovasc Res . 1978;12:444.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Aug 1, 1991

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