Treatment of Hypertension and the J Curve.

The optimal reduction in blood pressure when treating hypertension is obviously the one which reduces hypertension related cardiovascular morbidity and mortality as much as possible. Today's approach to the treatment of high blood pressure usually does not achieve this goal. In other words, treated hypertensive patients are still at increased risk of cardiovascular complications, such as strokes and myocardial infarcts, in spite of being treated with antihypertensive drugs. One possible explanation for this could be that the treated blood pressure rarely is brought down to strictly normotensive levels, as shown in numerous studies. This would suggest that a more vigorous lowering of blood pressure would provide greater benefit when treating hypertensive patients. On the other hand, the fact that the relationship between the level of blood pressure and risk may be J shaped suggests that vigorous lowering of blood pressure may increase cardiovascular risks, if blood pressure is brought down too far. A few open, retrospective, nonrandomized studies and one randomized placebo controlled study in the elderly (SHEP) have analyzed this issue. The Hypertension Optimal Treatment (HOT) study,1,2 which was published in June 1998,3 has addressed this problem in a prospective randomized trial. The discussions around the J curve with some emphasis on the HOT study will be briefly reviewed. (c)1999 by Le Jacq Communications, Inc.