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Environmental Health Perspectives Jul 2018Body burden of mercury has been linked to hypertension in populations exposed to high mercury levels. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Body burden of mercury has been linked to hypertension in populations exposed to high mercury levels.
OBJECTIVES
We summarized, extracted, and pooled the results of published studies that investigated mercury biomarkers and hypertension or blood pressure (BP) measurements to examine this potential relationship.
METHODS
We searched PubMed, Embase, and TOXLINE and selected studies according to defined inclusion criteria. Study quality was assessed by the Newcastle-Ottawa scale for cohort and case-control studies and the Quality Assessment Tool for cross-sectional studies. Study estimates were pooled using inverse-variance weighted random-effects models. Dose-response meta-analysis was performed with studies reporting hypertension and systolic BP for at least three mercury categories.
RESULTS
A total of 29 studies were included in the meta-analysis. The pooled odds ratio (OR) for hypertension, comparing the highest and lowest mercury exposure categories, was 1.35 [95% confidence interval (CI): 0.99, 1.83] for populations with hair mercury ≥2 μg/g in comparison with the OR of 1.12 (95% CI: 0.82, 1.52) for populations with hair mercury <2 μg/g. Positive associations were also observed for highest versus lowest mercury exposure categories on systolic and diastolic BP. Heterogeneity was observed for mercury species and exposure groups across different studies. Associations estimated using different mercury biomarkers generally agree with each other in the same study. A nonlinear dose-response relationship with an inflection point at 3 μg/g was identified, for both hypertension and systolic BP.
CONCLUSIONS
A significant positive association between mercury and hypertension and between mercury and BP was identified. The exposure dose is an important factor in determining the toxic effects of mercury on hypertension. https://doi.org/10.1289/EHP2863.
Topics: Blood Pressure; Dose-Response Relationship, Drug; Environmental Exposure; Environmental Pollutants; Humans; Hypertension; Mercury; Odds Ratio; Prevalence; Proportional Hazards Models
PubMed: 30073953
DOI: 10.1289/EHP2863 -
The Lancet. Digital Health Mar 2023Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes of... (Meta-Analysis)
Meta-Analysis
Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with hypertension: a systematic review and meta-analysis of randomised controlled trials.
BACKGROUND
Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes of interventions is not currently available. This study aimed to compare the effectiveness of SMS, smartphone application, and website interventions on improving blood pressure in adults with hypertension, and to report on their reach, uptake, and feasibility.
METHODS
In this systematic review and meta-analysis we searched CINAHL Complete, Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, and APA PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) published in English from Jan 1, 2009, that examined the effectiveness of digital health interventions on reducing blood pressure in adults with hypertension. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint was change in the mean of systolic blood pressure. Risk of bias was assessed with Cochrane Risk of Bias 2. Data on systolic and diastolic blood pressure reduction were synthesised in a meta-analysis, and data on reach, uptake and feasibility were summarised narratively. Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to evaluate the level of evidence. The study was registered with PROSPERO CRD42021247845.
FINDINGS
Of the 3235 records identified, 29 RCTs from 13 regions (n=7592 participants) were included in the systematic review, and 28 of these RCTs (n=7092 participants) were included in the meta-analysis. 11 studies used SMS as the primary mode of delivery of the digital health intervention, 13 used smartphone applications, and five used websites. Overall, digital health intervention group participants had a -3·62 mm Hg (95% CI -5·22 to -2·02) greater reduction in systolic blood pressure, and a -2·45 mm Hg (-3·83 to -1·07) greater reduction in diastolic blood pressure, compared with control group participants. No statistically significant differences between the three different modes of delivery were observed for both the systolic (p=0·73) and the diastolic blood pressure (p=0·80) outcomes. Smartphone application interventions had a statistically significant reduction in diastolic blood pressure (-2·45 mm Hg [-4·15 to -0·74]); however, there were no statistically significant reductions for SMS interventions (-1·80 mm Hg [-4·60 to 1·00]) or website interventions (-3·43 mm Hg [-7·24 to 0·38]). Due to the considerable heterogeneity between included studies and the high risk of bias in some, the level of evidence was assigned a low overall score. Interventions were more effective among people with greater severity of hypertension at baseline. SMS interventions reported higher reach and smartphone application studies reported higher uptake, but differences were not statistically significant.
INTERPRETATION
SMS, smartphone application, and website interventions were associated with statistically and clinically significant systolic and diastolic blood pressure reductions, compared with usual care, regardless of the mode of delivery of the intervention. This conclusion is tempered by the considerable heterogeneity of included studies and the high risk of bias in most. Future studies need to describe in detail the mediators and moderators of the effectiveness and implementation of these interventions, to both further improve their effectiveness as well as increase their reach, uptake, and feasibility.
FUNDING
European Union's Horizon 2020 Research and Innovation Programme.
Topics: Humans; Adult; Feasibility Studies; Hypertension; Blood Pressure; Randomized Controlled Trials as Topic
PubMed: 36828607
DOI: 10.1016/S2589-7500(23)00002-X -
Nutrients Apr 2020Suboptimal vitamin D status is associated with elevated blood pressure (BP) in children and adolescents. Whether vitamin D supplementation reduces BP remains unclear. To... (Meta-Analysis)
Meta-Analysis Review
Suboptimal vitamin D status is associated with elevated blood pressure (BP) in children and adolescents. Whether vitamin D supplementation reduces BP remains unclear. To systematically review whether vitamin D supplementation reduces BP in children and adolescents, we conducted a literature review according to the PRISMA statement. We included vitamin-D supplementation human interventions studies that reported on BP as an outcome. We searched PUBMED, MEDLINE, CINAHL, EMBASE, the Cochrane Library, and the clinical trials website. We also hand searched the references of the included articles and previous reviews of vitamin D therapy. No language or time restrictions were applied. We extracted data on population characteristics, baseline and endline vitamin D and BP values, and assessed the risk of bias of the included studies. We performed a narrative review of the findings, conducted a meta-analysis when possible, and performed sensitivity analyses to test the robustness of our results. We assessed the overall quality of the evidence produced in the meta-analysis. We included eight studies in our review and five studies in the meta-analysis, none of which included hypertensive only participants. The risk of bias was variable. In non-randomized studies, no effect of vitamin D supplementation was seen on systolic BP (SBP) (mean difference: 0.39 (95% confidence interval (CI): -0.9; 1.68) mmHg; 0.55; I = 0%). Only a significant decrease in diastolic BP (DBP) (mean difference: -1.87 (95% CI: -3.02; -0.72) mmHg; 0.001; I = 0%) was noted. Both analyses had a low quality of evidence. In randomized controlled trials (RCTs), no effect was noted on SBP (mean difference: -2.04 (95% CI: -5.12; 1.04) mmHg; 0.19; I = 71%) nor DBP (mean difference: 0.01 (95% CI: -1.09; 1.12) mmHg; 0.98; I = 0%). The final quality of evidence ranged between low and moderate. Sensitivity analyses did not affect the results. Vitamin D supplementation was found to be ineffective in lowering SBP and DBP in children and adolescents.
Topics: Adolescent; Adolescent Nutritional Physiological Phenomena; Blood Pressure; Child; Child Nutritional Physiological Phenomena; Dietary Supplements; Female; Humans; Hypertension; Male; Negative Results; Vitamin D
PubMed: 32331233
DOI: 10.3390/nu12041163 -
The Journal of Nutrition Apr 2015High blood pressure is a major health burden positively associated with the risk of cardiovascular disease and other chronic diseases. Flaxseed is a rich dietary source... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
High blood pressure is a major health burden positively associated with the risk of cardiovascular disease and other chronic diseases. Flaxseed is a rich dietary source of α-linolenic acid, lignans, and fiber, with a number of positive health benefits on blood pressure.
OBJECTIVE
The purpose of this study was to clarify the effect of flaxseed consumption on blood pressure. Further, the influence of baseline blood pressure, type of flaxseed supplementation, and duration of flaxseed supplementation on blood pressure was explored.
METHOD
PubMed (MEDLINE), Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library (Central) were searched through July 2014 for studies in which humans supplemented their habitual diet with flaxseed or its extracts (i.e., oil, lignans, fiber) for ≥2 wk.
RESULTS
A total of 11 studies (14 trials) were included in the analysis. Random-effects meta-analyses were conducted for the mean difference in blood pressure. Results indicated that flaxseed supplementation reduced systolic blood pressure (-1.77 mm Hg; 95% CI: -3.45, -0.09 mm Hg; P = 0.04) and diastolic blood pressure (-1.58 mm Hg; 95% CI: -2.64, -0.52 mm Hg; P = 0.003). These results were not influenced by categorization of participants into higher baseline blood pressure (≥130 mm Hg). An improvement in diastolic blood pressure was observed in subgroup analysis for consuming whole flaxseed (-1.93 mm Hg; 95% CI: -3.65, -0.21 mm Hg; P < 0.05) and duration of consumption ≥12 wk (-2.17 mm Hg; 95% CI: -3.44, -0.89 mm Hg; P < 0.05).
CONCLUSION
The present meta-analysis suggests that consumption of flaxseed may lower blood pressure slightly. The beneficial potential of flaxseed to reduce blood pressure (especially diastolic blood pressure) may be greater when it is consumed as a whole seed and for a duration of >12 wk.
Topics: Blood Pressure; Databases, Factual; Diet; Flax; Humans; Hypertension; Phytotherapy; Plant Preparations; Randomized Controlled Trials as Topic; Seeds; Sensitivity and Specificity
PubMed: 25740909
DOI: 10.3945/jn.114.205302 -
Aging Clinical and Experimental Research Apr 2023The objective of this systematic review and meta-analysis is to investigate whether nocturnal blood pressure fall, expressed by dipping patterns according to 24 h... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The objective of this systematic review and meta-analysis is to investigate whether nocturnal blood pressure fall, expressed by dipping patterns according to 24 h ambulatory blood pressure monitoring (ABPM), is associated with abnormal cognitive function (cognitive impairment or dementia).
METHODS
We systematically searched PubMed, Embase, and Cochrane databases to identify original articles through December 2022. We included any study with at least ten participants reporting on all-cause dementia or cognitive impairment incidence (primary outcome) or validated cognitive tests (secondary outcome) among ABPM patterns. We assessed risk of bias using Newcastle-Ottawa Quality Assessment Scale. We pooled odds ratios (OR) and standardized mean differences (SMD) using random-effect models for primary and secondary outcome, respectively.
RESULTS
In the qualitative synthesis, 28 studies examining 7595 patients were included. The pooled analysis of 18 studies showed that dippers had a 51% [OR 0.49(0.35-0.69)] lower risk of abnormal cognitive function and a 63% [OR 0.37(0.23-0.61)] lower risk of dementia alone, compared to non-dippers. Reverse dippers presented an up to sixfold higher risk [OR 6.06(3.15-11.64)] of abnormal cognitive function compared to dippers and an almost twofold higher risk [OR 1.81(1.26-2.6)] compared to non-dippers. Reverse dippers performed worse in global function neuropsychological tests compared with both dippers [SMD - 0.66(- 0.93 to - 0.39)] and non-dippers [SMD - 0.35(- 0.53 to - 0.16)].
CONCLUSION
Dysregulation of the normal circadian BP rhythm, specifically non-dipping and reverse dipping is associated with abnormal cognitive function. Further studies are required to determine potential underlying mechanisms and possible prognostic or therapeutic implications.
PROTOCOL REGISTRATION
PROSPERO database (ID: CRD42022310384).
Topics: Humans; Hypertension; Blood Pressure Monitoring, Ambulatory; Blood Pressure; Cognition; Dementia; Circadian Rhythm
PubMed: 36995461
DOI: 10.1007/s40520-023-02361-7 -
Diabetes & Metabolic Syndrome Jun 2023Currently, there is uncertainty as to whether blood pressure control in patients with type 2 diabetes should be treated to standard recommended levels or more... (Meta-Analysis)
Meta-Analysis
Effect of more versus less intensive blood pressure control on cardiovascular, renal and mortality outcomes in people with type 2 diabetes: A systematic review and meta-analysis.
BACKGROUND AND AIMS
Currently, there is uncertainty as to whether blood pressure control in patients with type 2 diabetes should be treated to standard recommended levels or more intensively.
METHODS
Medline, EMBASE, CENTRAL, and Clinicaltrials.gov were searched between January 1, 2000 and April 20th, 2023. Outcomes considered were all-cause mortality, stroke, heart failure, cardiovascular disease, albuminuria, coronary heart disease, and renal outcomes. Random-effects meta-analyses estimated pooled relative risks and mean differences.
RESULTS
Nine trials enrolling 11,005 participants with type 2 diabetes were included. The pooled mean difference between the intensive and standard treatment groups at follow-up were -7.98 mmHg (95% CI: 12.19 to -3.76) in systolic blood pressure, and -5.08 mmHg (-7.00 to -3.17) in diastolic blood pressure; although between study heterogeneity was high for both meta-analyses (I>85%). Intensive blood pressure lowering resulted in a reduction in risk of stroke (risk ratio 0.64; 0.52 to 0.79), and macro-albuminuria (0.77; 0.63 to 0.93). More intensive blood pressure control did not result in a statistically significant reduction in risk of all-cause mortality, heart failure, cardiovascular death, cardiovascular events, renal outcomes, and micro-albuminuria; although the direction of estimated effect was beneficial for all outcomes.
CONCLUSIONS
The use of intensive compared with standard blood pressure targets resulted in a significant reduction in blood pressure, stroke, and macro-albuminuria in patients with type 2 diabetes. The post-treatment blood pressure level in the intensive group was 125/73 mmHg, suggesting the current recommendations of 130/80 mmHg blood pressure or lower if tolerated, could be reduced further.
Topics: Humans; Blood Pressure; Diabetes Mellitus, Type 2; Albuminuria; Antihypertensive Agents; Cardiovascular Diseases; Stroke; Heart Failure; Hypertension
PubMed: 37257222
DOI: 10.1016/j.dsx.2023.102782 -
Scientific Reports Jul 2023Blood pressure (BP) reactivity to stress is associated with cardiovascular events and the incidence of hypertension, therefore, tolerance to stressors is important for... (Meta-Analysis)
Meta-Analysis
Blood pressure (BP) reactivity to stress is associated with cardiovascular events and the incidence of hypertension, therefore, tolerance to stressors is important for better management of cardiovascular risks. Exercise training is among the strategies that have been investigated as blunting the peak response to stressors, however, its efficacy is poorly explored. The aim was to explore the effects of exercise training (at least four weeks) on BP responses to stressor tasks in adults. A systematic review was performed in five electronic databases (MEDLINE, LILACS, EMBASE, SPORTDiscus, and PsycInfo). Twenty-three studies and one conference abstract was included in the qualitative analysis, totaling 1121 individuals, and k = 17 and 695 individuals in the meta-analysis. Favorable results (random-effects) for exercise training were found, with attenuated peak responses in systolic (standardized mean difference (SMD) = -0.34 [-0.56; -0.11], representing average reductions of 2.5 ± 3.6 mmHg) and null effects on diastolic BP (SMD = -0.20 [-0.54; 0.14], representing average reductions of 2.0 ± 3.5 mmHg). The analysis removing outliers' studies improved the effects for diastolic (SMD = -0.21 [-0.38; -0.05]) but not systolic BP (SMD = -0.33 [-0.53; -0.13]). In conclusion, exercise training seems to lower stress-related BP reactivity, therefore has the potential to improve patients' ability to better respond to stressful situations.
Topics: Adult; Humans; Blood Pressure; Exercise; Hypertension
PubMed: 37414810
DOI: 10.1038/s41598-023-38041-9 -
The Lancet. Global Health Aug 2023More people from sub-Saharan Africa aged between 20 years and 60 years are affected by end-organ damage due to underlying hypertension than people in high-income... (Meta-Analysis)
Meta-Analysis
BACKGROUND
More people from sub-Saharan Africa aged between 20 years and 60 years are affected by end-organ damage due to underlying hypertension than people in high-income countries. However, there is a paucity of data on the pattern of elevated blood pressure among adolescents aged 10-19 years in sub-Saharan Africa. We aimed to provide pooled estimates of high blood pressure prevalence and mean levels in adolescents aged 10-19 years across sub-Saharan Africa.
METHODS
In this systematic review and meta-analysis, we searched PubMed, Google Scholar, African Index Medicus, and Embase to identify studies published from Jan 1, 2010, to Dec 31, 2021. To be included, primary studies had to be observational studies of adolescents aged 10-19 years residing in sub-Saharan African countries reporting the pooled prevalence of elevated blood pressure or with enough data to compute these estimates. We excluded studies on non-systemic hypertension, in African people not living in sub-Saharan Africa, with participant selection based on the presence of hypertension, and with adult cohorts in which we could not disaggregate data for adolescents. We independently extracted relevant data from individual studies using a standard data extraction form. We used a random-effects model to estimate the pooled prevalence of elevated blood pressure and mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels overall and on a sex-specific basis. This study is registered with PROSPERO (CRD42022297948).
FINDINGS
We identified 2559 studies, and assessed 81 full-text studies for eligibility, of which 36 studies comprising 37 926 participants aged 10-19 years from ten (20%) of 49 sub-Saharan African countries were eligible. A pooled sample of 29 696 adolescents informed meta-analyses of elevated blood pressure and 27 155 adolescents informed meta-analyses of mean blood pressure. Sex data were available from 26 818 adolescents (14 369 [53·6%] were female and 12 449 [46·4%] were male) for the prevalence of elevated blood pressure and 23 777 adolescents (12 864 [54·1%] were female and 10 913 [45·9%] were male) for mean blood pressure. Study quality was high, with no low-quality studies. The reported prevalence of elevated blood pressure ranged from 4 (0·2%) of 1727 to 1755 (25·1%) of 6980 (pooled prevalence 9·9%, 95% CI 7·3-12·5; I?=99·2%, p<0·0001). Mean SBP was 111 mm Hg (95% CI 108-114) and mean DBP was 68 mm Hg (66-70). 13·4% (95% CI 12·9-13·9; p<0·0001) of male participants had elevated blood pressure compared with 11·9% (11·3-12·4; p<0·0001) of female participants (odds ratio 1·04, 95% CI 0·81-1·34; p<0·0001).
INTERPRETATION
To our knowledge, this systematic review and meta-analysis is the first systematic synthesis of blood pressure data specifically derived from adolescents in sub-Saharan Africa. Although many low-income countries were not represented in our study, our findings suggest that approximately one in ten adolescents have elevated blood pressure across sub-Saharan Africa. Accordingly, there is an urgent need to improve preventive heart-health programmes in the region.
FUNDING
None.
Topics: Adult; Humans; Male; Adolescent; Female; Young Adult; Blood Pressure; Africa South of the Sahara; Hypertension; Prevalence; Qualitative Research
PubMed: 37474231
DOI: 10.1016/S2214-109X(23)00218-8 -
The Cochrane Database of Systematic... Dec 2016Many antihypertensive agents exist today for the treatment of primary hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, or... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Many antihypertensive agents exist today for the treatment of primary hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, or both). Randomised controlled trials (RCTs) have been carried out to investigate the evidence for these agents. There is, for example, strong RCT evidence that thiazides reduce mortality and morbidity. Some of those trials used reserpine as a second-line therapy. However, the dose-related blood pressure reduction with this agent is not known.
OBJECTIVES
The primary objective of this review was to quantify the dose-related efficacy of reserpine versus placebo or no treatment in reducing systolic blood pressure (SBP) or diastolic blood pressure (DBP), or both.We also aimed to evaluate the dose-related effects of reserpine on mean arterial blood pressure (MAP) and heart rate (HR), as well as the dose-related effects on withdrawals due to adverse events.
SEARCH METHODS
We searched the Cochrane Hypertension Group Specialised Register (January 1946 to October 2016), CENTRAL (2016, Issue 10), MEDLINE (January 1946 to October 2016), Embase (January 1974 to October 2016), and ClinicalTrials.gov (all dates to October 2016). We also traced citations in the reference sections of the retrieved studies.
SELECTION CRITERIA
Included studies were truly randomised controlled trials (RCTs) comparing reserpine monotherapy to placebo or no treatment in participants with primary hypertension.
DATA COLLECTION AND ANALYSIS
We assessed methods of randomisation and concealment. We extracted and analysed data on blood pressure reduction, heart rate, and withdrawal due to adverse effects.
MAIN RESULTS
We found four RCTs (with a total of 237 participants) that met the inclusion criteria, none of which we found through the 2016 update search. The overall pooled effect demonstrates a statistically significant systolic blood pressure (SBP) reduction in participants taking reserpine compared with placebo (weighted mean difference (WMD) -7.92, 95% confidence interval (CI) -14.05 to -1.78). Because of significant heterogeneity across the trials, a significant effect in diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) could not be found. A dose of reserpine 0.5 mg/day or greater achieved the SBP effects. However, we could not determine the dose-response pattern because of the small number of trials. We did not combine data from the trial that investigated Rauwiloid against placebo with reserpine data from the remaining three trials. This is because Rauwiloid is a different alkaloid extract of the plant Rauwolfia serpentina, and the dose used is not comparable to reserpine. None of the included trials reported withdrawals due to adverse effects.
AUTHORS' CONCLUSIONS
Reserpine is effective in reducing SBP roughly to the same degree as other first-line antihypertensive drugs. However, we could not make definite conclusions regarding the dose-response pattern because of the small number of included trials. More RCTs are needed to assess the effects of reserpine on blood pressure and to determine the dose-related safety profile before the role of this drug in the treatment of primary hypertension can be established.
Topics: Antihypertensive Agents; Blood Pressure; Heart Rate; Humans; Hypertension; Randomized Controlled Trials as Topic; Rauwolfia; Reserpine
PubMed: 27997978
DOI: 10.1002/14651858.CD007655.pub3 -
Hypertension (Dallas, Tex. : 1979) Jul 2017There is a critical need for blood pressure-lowering strategies that have greater efficacy and minimal side effects. Low-dose combinations hold promise in this regard,... (Meta-Analysis)
Meta-Analysis Review
There is a critical need for blood pressure-lowering strategies that have greater efficacy and minimal side effects. Low-dose combinations hold promise in this regard, but there are few data on very-low-dose therapy. We, therefore, conducted a systematic review and meta-analysis of randomized controlled trials with at least one quarter-dose and one placebo and standard-dose monotherapy arm. A search was conducted of Medline, Embase, Cochrane Registry, Food and Drug Administration, and European Medicinal Agency websites. Data on blood pressure and adverse events were pooled using a fixed-effect model, and bias was assessed using Cochrane risk of bias. The review included 42 trials involving 20 284 participants. Thirty-six comparisons evaluated quarter-dose with placebo and indicated a blood pressure reduction of -4.7/-2.4 mm Hg (<0.001). Six comparisons were of dual quarter-dose therapy versus placebo, observing a -6.7/ -4.4 mm Hg (<0.001) blood pressure reduction. There were no trials of triple quarter-dose combination versus placebo, but one quadruple quarter-dose study observed a blood pressure reduction of -22.4/-13.1 mm Hg versus placebo (<0.001). Compared with standard-dose monotherapy, the blood pressure differences achieved by single (37 comparisons), dual (7 comparisons), and quadruple (1 trial) quarter-dose combinations were +3.7/+2.6 (<0.001), +1.3/-0.3 (NS), and -13.1/-7.9 (<0.001) mm Hg, respectively. In terms of adverse events, single and dual quarter-dose therapy was not significantly different from placebo and had significantly fewer adverse events compared with standard-dose monotherapy. Quarter-dose combinations could provide improvements in efficacy and tolerability of blood pressure-lowering therapy.
Topics: Antihypertensive Agents; Blood Pressure; Dose-Response Relationship, Drug; Drug Therapy, Combination; Humans; Hypertension; Medication Therapy Management; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 28584013
DOI: 10.1161/HYPERTENSIONAHA.117.09202