# J-curve bij gerandomiseerde bloeddrukstreefwaarden: SPRINT experimentele analyse

*geplaatst 2017-12-05 · Hypertensie · Circulation · doi 10.1161/CIRCULATIONAHA.117.030342 · https://hartvaat.nl/2017/12/05/j-curve-bij-gerandomiseerde-bloeddrukstreefwaarden-sprint-experimentele-analyse/*

Experimentele analyse van SPRINT die de J-curve onderzocht bij patiënten die gerandomiseerd waren naar verschillende bloeddrukstreefwaarden. Uniek ontwerp voor causale inferentie.

## English: J Curve in Patients Randomly Assigned to Different Systolic Blood Pressure Targets: An Experimental Approach to an Observational Paradigm.

This experimental SPRINT analysis addressed the J-curve concern by showing that low blood pressure achieved through randomization to intensive treatment was not associated with increased cardiovascular risk, distinguishing treatment-induced from disease-related hypotension.

## Abstract (original, from the publication)

BACKGROUND: Low systolic blood pressure (SBP) values are associated with an increased risk of cardiovascular events, giving rise to the so-called J-curve phenomenon. We assessed the association between on-treatment SBP levels, cardiovascular events, and all-cause mortality in patients randomized to different SBP targets. METHODS: Data from 2 large randomized trials that randomly allocated hypertensive patients at high risk for cardiovascular disease to intensive (SBP<120 mm Hg) or conventional (SBP<140 mm Hg) treatment were pooled and harmonized for outcomes and follow-up duration. Using natural cubic splines, we plotted the hazard ratio for all-cause mortality and cardiovascular events against the mean on-treatment SBP per treatment group. RESULTS: The pooled data consisted of 194 875 on-treatment SBP measurements in 13 946 patients (98.9%). During a median follow-up of 3.3 years, cardiovascular events occurred in 1014 patients (7.3%), and 502 patients died (3.7%). For both blood pressure targets, an identical shape of the J curve was present, with a nadir for cardiovascular events and all-cause mortality just below the SBP target. Patients in the lowest SBP stratum were older, had a higher body mass index, smoked more often, and had a higher frequency of diabetes mellitus and cardiovascular events. CONCLUSIONS: Low on-treatment SBP levels are associated with increased cardiovascular events and all-cause mortality. This association is independent of the attained blood pressure level because the J curve aligns with the SBP target. Our results suggest that the benefit or risk associated with intensive blood pressure-lowering treatment can be established only via randomized clinical trials. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01206062 and NCT00000620.

Auteurs: Deborah N Kalkman, Tom F Brouwer, Jim T Vehmeijer, Wouter R Berger, Reinoud E Knops, Robbert J de Winter, Ron J Peters, Bert-Jan H van den Born

---
Bron: Circulation, https://doi.org/10.1161/CIRCULATIONAHA.117.030342. Bijgewerkt 2026-07-03T13:26:19Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.