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February 2, 1990

Blood Pressure Reduction and the Risk of Myocardial Infarction

Author Affiliations

University of Leuven Belgium

University of Leuven Belgium

JAMA. 1990;263(5):660-661. doi:10.1001/jama.1990.03440050054025

To the Editor.—  Recently, Alderman et al1 have reported a J-shaped relationship between the degree of blood pressure fall, induced by treatment, and the occurrence of myocardial infarction in previously untreated patients with mild to moderate hypertension, followed up for an average of 4.2 years. Since both large and small reductions in diastolic blood pressure were associated with a higher incidence of myocardial infarction, these authors suggested that a moderate reduction in diastolic blood pressure (7 to 17 mm Hg) should perhaps be the goal of treatment for mild and moderate hypertensives.1Two other studies,2,3 one of which was double-blind,3 have reported a J-shaped relation between treated pressure and mortality in both actively treated hypertensives and control patients. Furthermore, Alderman et al1 did not predict events from the treated blood pressure at a constant interval following entry. Instead, they related outcome to the blood pressure