On the one hand, it can be argued from patho- physiological principles that very low SBP values (ie, <120 mmHg) may be appropriate to reduce myocardial work- At the same time, there is a concern that excessive lowering of DBP may impair coronary perfusion. At present and despite the ACCORD study,20 discussed below, there is no consensus on the question of what the most appropriate BP target(s) should be in individuals with latent or overt CAD or prominent CAD risk factors. We believe, however, that reasonable recommendations can be developed from a synthesis of the results from relevant epidemiological stud- ies, consideration of the theoretical issue of the J curve, data from animal studies, human studies involving surrogate end points, and randomized, clinical trials targeting different BP goals with cardiovascular events as end points. 3.1.1. Epidemiological Studies Although epidemiological correlations cannot be used as proof of the value of treatment, they are useful in establish- ing expectations for reasonable treatment strategies. More specifically, epidemiological data do not necessarily predict cardiovascular outcomes when BP is lowered as a result of antihypertensive treatment. Nevertheless, population studies such as the Prospective Studies Collaboration,6 the Framingham Heart Study,124 the Women s Health Initiative,125 and the Hisayama Study126 in Japan provide some support for a lower is better strategy for BP control. The debate about lower BP targets revolves around the issue of the so-called J curve and, more specifically, whether lower BP targets are appropriate or even safe for patients with CAD. 3.1.2. Coronary Perfusion, Autoregulation, and the J Curve Many studies demonstrate that lowering SBP, DBP, or both decreases overall cardiovascular risk. Yet, concern has persisted that excessive DBP lowering may have adverse Rosendorff et al Treatment of Hypertension in Patients With CAD 1383 consequences for the heart. 