Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 54, Issue 20, Pages 1827-1834Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2009.05.073
Keywords
coronary artery disease; diastolic pressure; hypertension; valve outcomes; myocardial infarction; pulse pressure; stroke; systolic pressure
Categories
Ask authors/readers for more resources
The topic of the J-curve relationship between blood pressure and coronary artery disease (CAD) has been the subject of much controversy for the past decades. An inverse relationship between diastolic pressure and adverse cardiac ischemic events (i.e., the lower the diastolic pressure the greater the risk of coronary heart disease and adverse outcomes) has been observed in numerous studies. This effect is even more pronounced in patients with underlying CAD. Indeed, a J-shaped relationship between diastolic pressure and coronary events was documented in treated patients with CAD in most large trials that scrutinized this relationship. In contrast to any other vascular bed, the coronary circulation receives its perfusion mostly during diastole; hence, an excessive decrease in diastolic pressure can significantly hamper perfusion. This adverse effect of too low a diastolic pressure on coronary heart disease leaves the practicing physician with the disturbing possibility that, in patients at risk, lowering blood pressure to levels that prevent stroke or renal disease might actually precipitate myocardial ischemia. However, these concerns should not deter physicians from pursuing a more aggressive control of hypertension, because currently blood pressure is brought to recommended target levels in only approximately one-third of patients. (J Am Coll Cardiol 2009; 54: 1827-34) (C) 2009 by the American College of Cardiology Foundation
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available