Revisiting the J-curve Phenomenon. An Old New Concept?

Cohort studies have demonstrated the association between blood pressure and increased cardiovascular events. There are different therapeutic strategies to achieve goals of systolic and diastolic blood pressure. For a long time, therapeutic targets were not well defined and the concept of "smaller is better" was used diffusely. However, clinical trials have shown the presence of a "J-curve" in different clinical situations: below a certain level of blood pressure, more aggressive reductions may not represent benefit and increase the incidence of adverse events in elderly patients, patients with coronary artery disease, patients with diabetes or chronic renal failure.