Coronary flow is maintained in the face of changing perfusion pressure (approximates to diastolic blood pressure [DBP]) by the process of autoregulation. A normal coronary artery is able to dilate fivefold (coronary flow reserve of 5); by contrast, coronary flow reserve falls in the presence of left ventricular hypertrophy [LVH] and/or coronary artery disease. Thus a fall in DBP that is normally well tolerated causes a fall in coronary flow, ECG changes, and left ventricular dysfunction in the presence of LVH and coronary artery disease. Such high-risk patients exhibit a J-curve relationship between DBP and death from coronary artery disease; lowering DBP (phase 5) to below the mid 80s would be imprudent in such patients.
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Cruickshank, J.M. J curve in antihypertensive therapy—Does it exist? A personal point of view. Cardiovasc Drug Ther 8, 757–760 (1994). https://doi.org/10.1007/BF00877123
- J curve
- high risk hypertensives
- coronary flow reserve
- left ventricular hypertrophy
- coronary artery disease