Antihypertensive treatment and renal protection: Is there a J-curve relationship?

Francesca Viazzi, Giovanna Leoncini, Guido Grassi, Roberto Pontremoli

Research output: Contribution to journalReview articlepeer-review


A bidirectional relationship between hypertension and kidney disease, with one exacerbating the effect of the other, is well established. Elevated blood pressure (BP) is a well-recognized, modifiable risk factor for cardiovascular (CV) disease as well as for development and progression of chronic kidney disease and, therefore, the identification of optimal BP target is a key issue in the management of renal patients. Recent large trials and real life cohort studies have indicated that below a definite BP value renal protection seems to plateau and too low levels may even be associated with a paradoxical increase in renal morbidity, thus reviving the debate about the so called BP -renal function J-curve relationship. Existing evidence supports a systolic target around 130 mm Hg to combine both renal and CV protection and possibly lower levels in the presence of overt proteinuria.

Original languageEnglish
Pages (from-to)1560-1574
Number of pages15
JournalJournal of Clinical Hypertension
Issue number11
Publication statusPublished - Nov 1 2018


  • albuminuria
  • chronic kidney disease
  • glomerular filtration rate
  • hypertension
  • J-curve relationship
  • RAAS-inhibition
  • target blood pressure

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Cardiology and Cardiovascular Medicine


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