Nobuyuki (Bill) Miyawaki, MD, is attending physician, Division of Nephrology

The observed relationship linking obesity, severity of hypertension, and increase in cardiovascular risk was traditionally thought to emanate from the increase in circulatory volume, persistently increased systemic resistance from obesity, and clustering of major cardiovascular risk factors (eg, hypercholesterolemia and diabetes mellitus) among obese patients.

The manuscript by Messerli and colleagues, entitled "Dangers of aggressively lowering blood pressure in coronary artery disease," raises a controversial issue with important clinical implications—the J-shaped curve.