The Relation Between Degree of Blood Pressure Reduction and Mortality Among Hypertensives in the Hypertension Detection and Follow-Up Program

Cooper, Sharon P.; Hardy, Robert J.; Labarthe, Darwin R.; Hawkins, C. Morton; Smith, E. O’Brian; Blaufox, M. Donald; Cooper, Charles J.; Entwisle, George; Maxwell, Morton H.

doi:10.1093/oxfordjournals.aje.a114812

Cited by 53 publications

(15 citation statements)

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“…In a recent critical review [44] of 13 studies involving more than 48,000 hypertensive subjects, it was found that the critical therapeutic threshold point for diastolic BP was 85 mm Hg, because at 75 mm Hg diastolic BP the rate of cardiac events was twice that seen at 85 mm Hg. This data analysis also revealed that the extent of fall in diastolic BP is important because the turning point of the J-shaped curve occurred at a 17-19 mm Hg drop in diastolic BP [46,47]. It is known that in hypertensives a large, sudden reduction of BP causes AION and other vascular accidents [39].…”

Section: Role Of Arterial Hypertension In Onh Ischemic Disordersmentioning

confidence: 71%

Role of Nocturnal Arterial Hypotension in Optic Nerve Head Ischemic Disorders

Hayreh

Podhajsky²,

Zimmerman³

1999

Ophthalmologica

284

193

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Objective: To investigate the role of nocturnal arterial hypotension, intraocular pressure (IOP) and heart rate in optic nerve head (ONH) ischemic disorders, and the effects of systemic factors and topical β-blocker eye-drops on nocturnal arterial hypotension and heart rate. Methods: We investigated prospectively, by 24-hour ambulatory blood pressure (BP) monitoring and diurnal curve of the IOP, 275 white patients with anterior ischemic optic neuropathy (AION – 114), normal tension glaucoma (NTG – 131) and primary open angle glaucoma (POAG – 30). Results: Hourly average BP data analyses showed a significantly greater drop in mean diastolic BP (p < 0.009) at night in NTG than AION. Cases with visual field deterioration had significantly (p = 0.05) lower minimum nighttime diastolic BP. Arterial hypertensives on oral hypotensive therapy showed a significantly lower mean nighttime systolic BP (p = 0.006) and larger mean percentage drop in systolic (p < 0.0001), diastolic (p = 0.0009) and mean (p < 0.0001) BPs. Normotensives and hypertensives without therapy had no such difference. IOP showed no significant correlation with visual field deterioration in any of these conditions. Patients using β-blocker eyedrops, compared with those not using them, had greater percentage drop in diastolic BP (p = 0.028), lower minimum nighttime diastolic BP (p = 0.072) and lower minimum nighttime heart rate (p = 0.002). Conclusions: Findings of our study suggest that nocturnal hypotension, by reducing the ONH blood flow below a crucial level during sleep in a vulnerable ONH, may play a role in the pathogenesis of AION and glaucomatous optic neuropathy (GON) and progression of visual loss in them. Thus, nocturnal hypotension may be the final insult in a multifactorial situation.

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Section: Role Of Arterial Hypertension In Onh Ischemic Disordersmentioning

confidence: 71%

Role of Nocturnal Arterial Hypotension in Optic Nerve Head Ischemic Disorders

Hayreh

Podhajsky²,

Zimmerman³

1999

Ophthalmologica

284

193

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“…Twelve studies were identified [5, 22,[26][27][28]57,[59][60][61][62][63][64][65]. They constructed best-fitting summary curves for both cardiac events and cardiac mortality and both curves were J-shaped.…”

Section: Follow-up Y Relationship Between P-p Sbp Dbp and Cardiovmentioning

confidence: 99%

“…Thus, classic β-blockers such as propranolol do not improve arterial compliance [78]; this fact could account for the poor results of β-blockers in preventing cardiovascular events in the hypertensive elderly [79] (ie, the HEP study [22], the Medical Research Council [MRC] study in the Elderly [29], and the Losartan Intervention for Endpoint reduction in hypertension study [80]), where there was a wide P-P (76-97 mm Hg); in contrast to the relatively good results in younger patients Cooper et al [60] 10,053 (ie, the International Prospective Primary Prevention Study in Hypertension [64], the MRC I study [28], the Metoprolol Atherosclerosis Prevention in Hypertensives study [81], and the United Kingdom Prospective Diabetes Study [82]), where there was a relatively narrow P-P (59-65 mm Hg) in addition to high sympathetic drive and renin activity. β-blockers would also be the preferred treatment for hypertensives with overt ischemia, due to their antiischemic properties (partly via slowing heart rate, thus prolonging coronary artery filling time).…”

Section: Type Of Antihypertensive Agent and The J-curvementioning

confidence: 99%

The J-curve in hypertension

Cruickshank

2003

Curr Cardiol Rep

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The J-curve debate has continued for 25 years. Dependency upon observational and retrospective studies has confused the issue; only the full publication of data from the prospective, randomized Hypertension Optimal Treatment (HOT) study has thrown genuine light on the problem. Many examples of the J-curve relationship between blood pressure and cardiovascular/noncardiovascular events are due to reverse causality, where underlying disease (eg, poor left ventricular function, poor general health, poorly compliant/stiff arteries) is the cause of both the low blood pressure and the increased risk of both cardiovascular and noncardiovascular events. The J-curve in patients with stiff arteries (wide pulse pressure) may be exacerbated by treatment. From the full publication of the HOT study database it is now reasonable to conclude that for nonischemic hypertensive subjects the therapeutic lowering of diastolic blood pressure (DBP) to the low 80s mm Hg is beneficial, but it is safe (though unproductive) to go lower. However, in the presence of coronary artery disease (limited coronary flow reserve) there is a J-curve relationship between treated DBP and myocardial infarction, but not for stroke. In such high-risk (for myocardial infarction) cases it would be prudent to avoid lowering DBP to below the low 80s mm Hg.

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“…These ''J-shaped curve'' concepts and concerns have received some support from the results of longitudinal CONTACT Henry L. Elliott henrylelliott@aol.com Institute of Pharmaceutical and Biomedical Sciences, 34 Randolph Gate, Glasgow G11 7DE, UK cohort studies of treated hypertensive patients (9)(10)(11)(12)(13) and from retrospective analyses of outcome trials. [14][15][16][17] Overall, it has been suggested that the J-shaped curve is more likely to be encountered in patients with pre-existing coronary artery disease (CAD) [18] and this concept has been reinforced by retrospective analyses from recent clinical trials in patients at high cardiovascular risk.…”

Section: Introductionmentioning

confidence: 99%

Prognostic importance of pretreatment and on-treatment blood pressure: Further analysis of the ACTION database and the effect of nifedipine gastrointestinal therapeutic system

et al. 2016

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This retrospective further analysis of the ACTION database evaluated the relationships between baseline blood pressure (BP), on-treatment BP (after 6 weeks) and subsequent cardiovascular outcomes. Analyses were performed using multivariate Cox proportional hazard models. Statistically significant (p < 0.001) and consistent patterns were noted between the risk of major cardiovascular endpoints and both baseline SBP and on-treatment SBP. The lowest risk of debilitating stroke was apparent in those patients with baseline SBP < 120mmHg, with a hazard ratio in this lowest BP group of 0.45 (95% confidence interval 0.28, 0.72), compared to the referent highest BP group (SBP < 150mmHg). Adjusting the model for treatment (nifedipine or placebo) did not modify the conclusions in any statistical or clinically meaningful way. Corresponding and similar results were obtained for pulse pressure but diastolic blood pressure (DBP) was not a consistently useful predictor of outcome. These data confirm the predictive importance of on-treatment SBP (but not DBP) and contribute to the debate about treatment-related BP targets. In this analysis, treatment with nifedipine gastrointestinal therapeutic system in high-risk patients with coronary artery disease was not associated with any increase in cardiovascular risk, even with baseline SBP5120mmHg.

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The Relation Between Degree of Blood Pressure Reduction and Mortality Among Hypertensives in the Hypertension Detection and Follow-Up Program

Cited by 53 publications

References 0 publications

Role of Nocturnal Arterial Hypotension in Optic Nerve Head Ischemic Disorders

Role of Nocturnal Arterial Hypotension in Optic Nerve Head Ischemic Disorders

The J-curve in hypertension

Prognostic importance of pretreatment and on-treatment blood pressure: Further analysis of the ACTION database and the effect of nifedipine gastrointestinal therapeutic system

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