ReviewAmerican heart journal plus : cardiology research and practice2021
The diastolic blood pressure J-curve revisited: An update.
Review in American heart journal plus : cardiology research and practice, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.
- Blood pressure lowering in isolated diastolic hypertension and cardiovascular risk: an individual patient data meta-analysis.European heart journal · 2026Pooled it
- Epidemiology of pacemaker implantation in the community: findings from the Framingham Heart Study.International journal of cardiology. Heart & vasculature · 2026Article
- Causal effect heterogeneity estimation using summary statistics.Research square · 2026Article
- Multi‑feature Prediction Model for Coronary Heart Disease Comorbidity in Middle‑aged and Older Adults with COPD Based on Machine Learning and SHAP.International journal of chronic obstructive pulmonary disease · 2026Article
- Blood pressure and adverse cardiovascular outcomes in older people with type 2 diabetes and chronic kidney disease: Findings based on the Clinical Practice Research Datalink databases in England.Diabetes, obesity & metabolism · 2026Article
- Blood pressure management in secondary prevention after myocardial infarction.Cardiovascular research · 2025Review
- A different perspective on studying stroke predictors: joint models for longitudinal and time-to-event data in a type 2 diabetes mellitus cohort.Cardiovascular diabetology · 2025Article
- Time to Mortality and Predictive Factors Among Adult Heart Failure Patients: Lessons From a Resource-Limited Setting.Cardiology research and practice · 2025Article
- Effect of Population-Level Blood Pressure Treatment Strategies on Cardiovascular and Cognitive Outcomes.Circulation. Cardiovascular quality and outcomes · 2024Article
- A retrospective single-centre study on determinants of high-risk coronary artery calcium (CAC) score in women.The British journal of cardiology · 2024Article
- Highlights of the 2022 Vietnamese Society of Hypertension guidelines for the diagnosis and treatment of arterial hypertension: The collaboration of the Vietnamese Society of Hypertension (VSH) task force with the contribution of the Vietnam National Heart Association (VNHA): The collaboration of the Vietnamese Society of Hypertension (VSH) task force with the contribution of the Vietnam National Heart Association (VNHA).Journal of clinical hypertension (Greenwich, Conn.) · 2022Article
- Taking a step back: Making sense of evidence on diastolic blood pressure in the context of targets for older adults.American heart journal plus : cardiology research and practice · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Hypertension remains a leading cause of morbidity and mortality. Recent treatment guidelines stress more strict systolic blood pressure (SBP) targets without regard for abnormally low achieved diastolic blood pressures (DBP). However, as DBP falls below a critical level, adverse events increase, the so-called J-shaped curve. Proponents argue that the low DBP is causative due to reduced coronary perfusion during diastole with obstructive coronary artery disease (CAD), whereas others postulate the J-curve represents reverse causality from underlying comorbidity. Most data are observational, derived from population-based cohorts or post-hoc analyses of randomized controlled trials (RCT) conducted for other reasons. The purpose of this review is to analyze the observational studies performed over the last decade addressing the J-curve, with consideration of earlier data. Overall, a J-curve exists, but it remains uncertain whether low DBP is causative or instead reflects reverse causation from either diseased vasculature (widened pulse pressure) or severe underlying comorbidity. The most convincing data for causation come from studies restricted to patients with documented CAD, with evidence suggesting revascularization may mitigate risk. RCTs are needed to determine if a low DBP should preclude intensification of therapy, especially with documented CAD. Firm recommendations cannot be made with contemporary data.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.