Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

J curve in antihypertensive therapy—Does it exist? A personal point of view

  • 27 Accesses

  • 9 Citations


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.

This is a preview of subscription content, log in to check access.


  1. 1.

    Strandgaard S, Haunso S. Why does antihypertensive treatment prevent stroke but not myocardial infarction?Lancet 1987;2:658–661.

  2. 2.

    Hricik DE, Browing PJ, Kopelman R, Goorno WE, Madias NE, Dzau VJ. Captopril-induced functional renal insufficiency in patients with bilateral renal-artery stenosis in a solitary kidney.N Engl J Med 1983;308:373–376.

  3. 3.

    Oliver M. Coronary flow reserve and the J curve.Br Med J 1988;297:1607.

  4. 4.

    Klocke FJ. Measurements of coronary flow reserve: Defining pathophysiology versus making decision about patient care.Circulation 1987;76:1183–1189.

  5. 5.

    Pepi M, Alimento M, Maltagliati A, Guazzi MD. Cardiac hypertrophy in hypertension. Repolarization abnormalities elicited by rapid lowering of pressure.Hypertension 1988;11:84–91.

  6. 6.

    Collins P, Cruickshank JM, Keegan J, Fox K. Acute blood pressure reduction causes an impairment of left ventricular function in hypertensive patients with coronary heart disease and left ventricular hypertrophy.Eur Heart J 1991;12(Suppl):242.

  7. 7.

    Polese A, De Cesare N, Montorsi P, et al. Upward shift of the lower range of coronary flow autoregulation in hypertensive patients with hypertrophy of the left ventricle.Circulation 1991;83:845–853.

  8. 8.

    MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease. Part 1. Prolonged differences in blood pressure: Prospective observational studies corrected for the regression dilution bias.Lancet 1990;335:765–774.

  9. 9.

    Cohen JD, Butler SM, Cutler JS, Neaton JD (for the MRFIT Research Group). Relationship between blood pressure change and mortality among MRFIT hypertensives.Circulation 1991;84(Suppl):II137.

  10. 10.

    Cruickshank JM. Coronary flow reserve and the J-curve relation between diastolic blood pressure and myocardial infarction.Br Med J 1988;297:1227–1230.

  11. 11.

    Cruickshank JM, Thorp JM, Zacharias FJ. Benefits and potential harm of lowering high blood pressure.Lancet 1987;1:581–584.

  12. 12.

    Farnett L, Mulrow CD, Linn WD, Lucey CR, Tuley MR. The J-curve phenomenon and the treatment of hypertension.JAMA 1991;265:489–495.

  13. 13.

    D'Agostino RB, Belanger AJ, Kanel WB, Cruickshank JM. Relation of low diastolic blood pressure to coronary heart disease death in presence of myocardial infarction: The Framingham study.Br Med J 1991;303:385–389.

  14. 14.

    Cruickshank JM, Polese A. Left ventricular hypertrophy and the possible harmful effect of the excessive lowering of diastolic blood pressure. In: Cruickshank JM, Messerli FH, eds.Left Ventricular Hypertrophy and its Regression. 1992:61.

  15. 15.

    Strauer BE. Left ventricular hypertrophy and coronary flow reserve. In: Cruickshank JM, Messerli FH, eds.Left Ventricular Hypertrophy and its Regression. 1992:49.

Download references

Author information

Correspondence to Dr. J. M. Cruickshank.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Cruickshank, J.M. J curve in antihypertensive therapy—Does it exist? A personal point of view. Cardiovasc Drug Ther 8, 757–760 (1994).

Download citation

Key Words

  • J curve
  • high risk hypertensives
  • autoregulation
  • coronary flow reserve
  • left ventricular hypertrophy
  • coronary artery disease