Isolated systolic hypertension and the J-curve of cardiovascular disease risk☆
Based on the Donald A. McDonald Memorial Lecture given on October 9, 2009 at the Artery 9 meeting, Cambridge University, UK.
- https://doi.org/10.1016/j.artres.2010.01.001How to use a DOI?
- J-cuvre, Isolated systolic hypertension, Reverse causality, Epidemiology
Controversy persists regarding the presence and significance of blood pressure “J-curves” of increased cardiovascular disease (CVD) risk as they relate to older people with isolated systolic hypertension (ISH). Age is an important effect modifier favoring diastolic blood pressure (DBP) in young adults, systolic blood pressure (SBP) in middle-aged, and pulse pressure (PP) in the elderly as predictors of CVD events. By contrast, a recent Framingham Heart Study showed that combined blood pressure components increased the prediction of CVD risk over any single blood pressure component. Interestingly, of the 4 blood pressure components [DBP, SBP, PP, and mean arterial pressure (MAP)] only DBP showed non-linear tendencies, which presented as a J-curve of increased CVD risk in this primary prevention study. A low DBP was associated with increased PP, and hence, was a marker for increased arterial stiffness; thus, risk was defined by increased PP that resulted in decreased DBP and increased SBP. On the other hand, when primary CVD events result in poor cardiac function, the presence of combined SBP and DBP J-curves serve as predictors of secondary CVD events—so called “reverse causality”; thus, risk is associated with decreased rather than by increased SBP. Lastly, treatment-induced cardiac risk is a potential third explanation for J-curves that occur in the presence of hemodynamically significant coronary artery stenosis. The thesis of this presentation is that a treatment-induced cardiac event, as an explanation for the J-curve risk, occurs infrequently as compared to arterial stiffness or reverse causality; furthermore, the exact point at which the J-curve begins, remains in doubt. Nevertheless, only a prospective trial with baseline and pre-event blood pressure determinations can establish the presence and frequency of treatment-induced J-curve risk.
- © 2010 Association for Research into Arterial Structure and Physiology. Published by Elsevier B.V. All rights reserved.
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Cite this article
TY - JOUR AU - Stanley S. Franklin PY - 2010 DA - 2010/02 TI - Isolated systolic hypertension and the J-curve of cardiovascular disease risk☆ JO - Artery Research SP - 1 EP - 6 VL - 4 IS - 1 SN - 1876-4401 UR - https://doi.org/10.1016/j.artres.2010.01.001 DO - https://doi.org/10.1016/j.artres.2010.01.001 ID - Franklin2010 ER -