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Böhm M, Schumacher H, Leong D, Mancia G, Unger T, Schmieder R, Custodis F, Diener HC, Laufs U, Lonn E, Sliwa K, Teo K, Fagard R, Redon J, Sleight P, Anderson C, O'Donnell M, Yusuf S. Systolic blood pressure variation and mean heart rate is associated with cognitive dysfunction in patients with high cardiovascular risk. Hypertension 2015; 65:651-61. [PMID: 25583157 DOI: 10.1161/hypertensionaha.114.04568] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
UNLABELLED Elevated systolic blood pressure (SBP) correlates to cognitive decline and incident dementia. The effects of heart rate (HR), visit to visit HR variation, and visit to visit SBP variation are less well established. Patients without preexisting cognitive dysfunction (N=24 593) were evaluated according to mean SBP, SBP visit to visit variation (coefficient of variation [standard deviation/mean×100%], CV), mean HR, and visit to visit HR variation (HR-CV) in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease. Cognitive function was assessed with mini mental state examination. Cognitive dysfunction (fall in mini mental state examination ≤24 points), important cognitive decline (drop of ≥5 points), and cognitive deterioration (drop of >1 point per year or decline to <24 points) were assessed. SBP and HR were measured over 10.7±2.2 (mean±SD) visits. Mean SBP, mean HR, and SBP-CV were associated with cognitive decline, dysfunction, and deterioration (all P<0.01, unadjusted). After adjustment, only SBP-CV (P=0.0030) and mean HR (P=0.0008) remained predictors for cognitive dysfunction (odds ratios [95% confidence intervals], 1.32 [1.10-1.58] for 5th versus 1st quintile of SBP-CV and 1.40 [1.18-1.66] for 5th versus 1st quintile of mean HR). Similar effects were observed for cognitive decline and deterioration. SBP-CV and mean HR showed additive effects. In conclusion, SBP-CV and mean HR are independent predictors of cognitive decline and cognitive dysfunction in patients at high CV risk. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT 00153101.
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Affiliation(s)
- Michael Böhm
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.).
| | - Helmut Schumacher
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Darryl Leong
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Giuseppe Mancia
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Thomas Unger
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Roland Schmieder
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Florian Custodis
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Hans-Christoph Diener
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Ulrich Laufs
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Eva Lonn
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Karen Sliwa
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Koon Teo
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Robert Fagard
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Josep Redon
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Peter Sleight
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Craig Anderson
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Martin O'Donnell
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Salim Yusuf
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
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