Volpe, Massimo;
Gallo, Giovanna;
Guzik, Tomasz J;
Williams, Bryan;
Messerli, Franz H;
(2025)
Blood pressure management in secondary prevention after myocardial infarction.
Cardiovascular Research
, Article cvaf145. 10.1093/cvr/cvaf145.
(In press).
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Abstract
The management of blood pressure (BP) in secondary prevention after acute myocardial infarction (AMI) remains a matter of debate. Since no dedicated trials have specifically addressed BP control in patients recovering from an acute coronary syndrome, there are no evidence-based, prospective data to define precise BP targets in this population. Moreover, major international guidelines devote surprisingly little attention to BP management in the post-AMI setting, despite its recognized importance in reducing recurrent cardiovascular events. On one hand, BP-lowering may improve cardiac function by reducing afterload and myocardial oxygen consumption and by facilitating favorable ventricular remodeling. On the other, the concept of a J-shaped association—whereby excessive lowering of diastolic blood pressure (DBP) may paradoxically increase cardiovascular risk, particularly in the early post-acute myocardial infarction (AMI) period—remains a matter of ongoing uncertainty. Despite decades of investigation, this issue has not been definitively resolved and continues to raise debate within both the scientific community and among clinicians. In this review, we examine the current evidence supporting BP control in the context of secondary prevention following acute myocardial infarction (AMI), with an updated focus on the ongoing debate surrounding the potential implications of the J-shaped phenomenon.
| Type: | Article |
|---|---|
| Title: | Blood pressure management in secondary prevention after myocardial infarction |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/cvr/cvaf145 |
| Publisher version: | https://doi.org/10.1093/cvr/cvaf145 |
| Language: | English |
| Additional information: | © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
| Keywords: | J-curve phenomenon, acute coronary syndromes, blood pressure management, coronary artery disease, secondary prevention |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10214484 |
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