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Palomo-Piñón S, Antonio-Villa NE, Rangel-Zertuche RA, Berumen-Lechuga MG, Medina-Serrano JM, García-Cortés LR, Mejia-Rodríguez O, León-Vázquez MDLL, González-Dzib RDS, González-Coronado VJ, Álvarez-Aguilar C, Paniagua-Sierra JR, Alcocer L. Clinical and treatment profiles of arterial hypertension in Mexico during the COVID-19 pandemic: a cross-sectional survey endorsed by the "Collaborative Group on Arterial Hypertension". Front Public Health 2024; 12:1385349. [PMID: 39071149 PMCID: PMC11272620 DOI: 10.3389/fpubh.2024.1385349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/18/2024] [Indexed: 07/30/2024] Open
Abstract
Background Arterial hypertension is highly prevalent in Mexico; nevertheless, there are limited insights regarding its management during the COVID-19 pandemic. Here, we estimate the prevalence of clinical and treatment profiles of arterial hypertension and explore associated factors for undiagnosed and uncontrolled hypertension using a cross-sectional survey endorsed by the Collaborative Group on Arterial Hypertension from the Mexican Institute of Social Security. Methods Our survey was conducted from May to November 2021 using the May-Measurement Month 2021 protocols of the International Society of Hypertension. Arterial hypertension (defined as: blood pressure [BP] ≥140/90 mmHg, previous diagnosis, or taking antihypertensives) and its clinical and treatment profiles were classified according to the World Hypertension League Expert Committee. Mixed-effects logistic regression models were used to explore associated factors for undiagnosed and uncontrolled hypertension. Results Among 77,145 screened participants (women: 62.4%; median age: 46 [IQR: 32-59] years), the prevalence of arterial hypertension was 35.7% (95% CI: 35.3-36.0, n = 27,540). Among participants with arterial hypertension, 30.9% (95% CI: 30.4-31.5, n = 8,533) were undiagnosed, 6.6% (95% CI: 6.3%-6.9%, n = 1,806) were diagnosed but untreated, 43.4% (95% CI: 42.9-44.0, n = 11,965) had uncontrolled hypertension, and only 19% (95% CI: 18.6%-19.5%, n = 5,236) achieved hypertension control (BP < 130/80 mmHg). Explored associated factors for undiagnosed and uncontrolled hypertension include being men, living in the central and southern regions, lower educational attainments, higher use of pharmacological agents, and previous COVID-19 infection. Conclusion Our findings suggest that adverse arterial hypertension profiles, mainly undiagnosed and uncontrolled hypertension, were highly prevalent during the context of the COVID-19 pandemic in Mexico.
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Affiliation(s)
- Silvia Palomo-Piñón
- Unidad de Investigación Médica en Enfermedades Nefrológicas Siglo XXI (UIMENSXII), Unidad Médica de Alta Especialidad Hospital de Especialidades “Dr. Bernardo Sepúlveda G” Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Mexico City, Mexico
- Grupo Colaborativo en Hipertensión Arterial (GCHTA), Mexico City, Mexico
| | | | - Ricardo Alfonso Rangel-Zertuche
- Jefatura Prestaciones Médicas, Órgano de Operación Administrativa Desconcentrada, Instituto Mexicano del Seguro Social, Coahuila, Mexico
| | - María Guadalupe Berumen-Lechuga
- Jefatura de Servicios de Prestaciones Médicas, Órgano de Operación Administrativa Desconcentrada México Poniente, Toluca, Mexico
| | - Julio Manuel Medina-Serrano
- Coordinación de Planeación y Enlace Institucional, Órgano de Operación Administrativa Desconcentrada en Sinaloa, Instituto Mexicano del Seguro Social, Culiacán, Sinaloa, Mexico
| | - Luis Rey García-Cortés
- Coordinación de Planeación y Enlace Institucional, Jefatura de Servicios de Prestaciones Médicas, Órgano de Operación Administrativa Desconcentrada Regional Estado de México Oriente, Instituto Mexicano del Seguro Social, Oriente, Mexico City, Mexico
| | - Oliva Mejia-Rodríguez
- Centro de Investigación Biomédica de Michoacán del Instituto Mexicano del Seguro Social and by Escuela de Medicina, Campus Morelia, UVAQ, Michoacán, Mexico
| | - María de la Luz León-Vázquez
- Coordinación de Planeación e Enlace Institucional, Órgano Operativo de Administración Desconcentrada en Tlaxcala, Instituto Mexicano del Seguro Social, Tlaxcala, Mexico
| | | | - Vidal José González-Coronado
- Departamento de Cardiología Hospital Regional “1 Octubre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City, Mexico
| | - Cleto Álvarez-Aguilar
- Facultad de Ciencias Médicas y Biológicas “Dr. Ignacio Chávez”, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Michoacan, Mexico
| | - José Ramón Paniagua-Sierra
- Jefe de la Unidad de Investigación Médica en Enfermedades Nefrológicas Siglo XXI, Unidad Médica de Alta Especialidad Hospital de Especialidades “Dr. Bernardo Sepúlveda G” - Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Luis Alcocer
- Instituto Mexicano de Salud Cardiovascular, Mexico City, Mexico
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Palomo-Piñón S, Antonio-Villa NE, García-Cortés LR, Moreno-Noguez M, Alcocer L, Álvarez-López H, Cardona-Muñoz EG, Chávez-Mendoza A, Díaz-Díaz E, Enciso-Muñoz JM, Galván-Oseguera H, Rosas-Peralta M. Patients Living With Arterial Hypertension in Mexico: First Insights of The Mexican Registry of Arterial Hypertension (RIHTA Study). Am J Hypertens 2024; 37:503-513. [PMID: 38466237 PMCID: PMC11176274 DOI: 10.1093/ajh/hpae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/30/2024] [Accepted: 03/03/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Arterial hypertension is a significant cause of morbidity and mortality in Mexico. However, there is limited evidence to understand blood pressure management and cardiometabolic profiles. Here, we aim to assess the prevalence of controlled and uncontrolled blood pressure, as well as the prevalence of cardiometabolic risk factors among patients from the Mexican Registry of Arterial Hypertension (RIHTA). METHODS We conducted a cross-sectional analysis of participants living with arterial hypertension registered on RIHTA between December 2021 and April 2023. We used both the 2017 ACC/AHA and 2018 ESC/ESH thresholds to define controlled and uncontrolled arterial hypertension. We considered eleven cardiometabolic risk factors, which include overweight, obesity, central obesity, insulin resistance, diabetes, hypercholesterolemia, hypertriglyceridemia, low HDL-C, high LDL-C, low-eGFR, and high cardiovascular disease (CVD) risk. RESULTS In a sample of 5,590 participants (female: 61%, n = 3,393; median age: 64 [IQR: 56-72] years), the prevalence of uncontrolled hypertension varied significantly, depending on the definition (2017 ACC/AHA: 59.9%, 95% CI: 58.6-61.2 and 2018 ESC/ESH: 20.1%, 95% CI: 19.0-21.2). In the sample, 40.43% exhibited at least 5-6 risk factors, and 32.4% had 3-4 risk factors, chiefly abdominal obesity (83.4%, 95% CI: 82.4-84.4), high LDL-C (59.6%, 95% CI: 58.3-60.9), high CVD risk (57.9%, 95% CI: 56.6-59.2), high triglycerides (56.2%, 95% CI: 54.9-57.5), and low HDL-C (42.2%, 95% CI: 40.9-43.5). CONCLUSIONS There is a high prevalence of uncontrolled hypertension interlinked with a high burden of cardiometabolic comorbidities in Mexican adults living with arterial hypertension, underscoring the urgent need for targeted interventions and better healthcare policies to reduce the burden of the disease in our country.
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Affiliation(s)
- Silvia Palomo-Piñón
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Grupo Colaborativo en Hipertensión Arterial (GCHTA), Ciudad de México, México
| | | | - Luis Rey García-Cortés
- Coordinación de Planeación y Enlace Institucional, Jefatura de Servicios de Prestaciones Médicas, Órgano de Operación Administrativa Desconcentrada Regional Estado de México Oriente, Instituto Mexicano del Seguro Social, Estado de México, Oriente, México
| | - Moises Moreno-Noguez
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Coordinación Clínica de Educación e Investigación en Salud, Unidad de Medicina Familiar No. 55 Zumpango, Órgano de Operación Administrativa Desconcentrada Regional Estado de México Oriente, Estado de México, México
| | - Luis Alcocer
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Hospital Ángeles del Pedregal, Ciudad de México, México
| | - Humberto Álvarez-López
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Hospital Puerta de Hierro Andares, Zapopan, Jalisco, México
| | - Ernesto G Cardona-Muñoz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Adolfo Chávez-Mendoza
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Enrique Díaz-Díaz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - José Manuel Enciso-Muñoz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Hospital General Zacatecas "Luz González Cosio", Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Zacatecas, Zacatecas, México
- Asociación Nacional de Cardiólogos de México, Ciudad de México, México
| | - Héctor Galván-Oseguera
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Martín Rosas-Peralta
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Titular Academia Nacional de Medicina, Ciudad de México, México
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Fan L, Liu L, Zhao Y, Mo Y, Li J, Cai L. Trends in the prevalence and economic burden of hypertension and its socioeconomic disparities in rural southwestern China: two repeated cross-sectional studies. BMJ Open 2023; 13:e076694. [PMID: 37977876 PMCID: PMC10660421 DOI: 10.1136/bmjopen-2023-076694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study aimed to analyse trends in the prevalence and economic burden of hypertension and its socioeconomic disparities in rural southwestern China. DESIGN Two repeated cross-sectional studies were conducted to collect interview and health examination data among individuals aged ≥35 years in rural Yunnan Province, China. SETTING Three rural areas of Yunnan, China. PARTICIPANTS We invited 8187 consenting participants in 2010-2011 and 7572 consenting participants in 2020-2021 to undergo interviews and health examinations. RESULTS The standardised prevalence of hypertension significantly increased from 26.1% in 2011 to 40.4% in 2021 (p<0.01), and the per capita direct, indirect and disease economic burdens increased from US$1323, US$46 and US$1369 to US$2196, US$49 and US$2244, respectively. In addition to the indirect economic burden, the direct and disease economic burdens increased significantly. The prevalence of hypertension was higher in illiterate population, among participants with low annual household income per capita, and participants with good access to medical services than in their counterparts who had good education, high annual household income per capita and poor access to medical services (all p<0.05). Moreover, the prevalence of hypertension showed a downward trend with improvement in socioeconomic position (SEP) (p<0.05). The per capita direct and disease economic burdens increased most in participants with low SEP, but the per capita indirect economic burden increased most in participants with upper-middle SEP. CONCLUSIONS The prevalence and economic burden of hypertension have visibly accelerated in rural Yunnan Province over the 10 years studied, and socioeconomic disparities have been found in the prevalence and economic burden of hypertension. These findings highlight that socioeconomic differentials should be tailored to address the timing of effective interventions for hypertension prevention and control and reduce the economic burden of hypertension in rural southwestern China.
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Affiliation(s)
- Luming Fan
- School of Nursing, Kunming Medical University, Kunming, China
- School of Public Health, Kunming Medical University, Kunming, China
| | - Lan Liu
- School of Public Health, Kunming Medical University, Kunming, China
| | - Yi Zhao
- School of Public Health, Kunming Medical University, Kunming, China
| | - Yi Mo
- School of Public Health, Kunming Medical University, Kunming, China
| | - Jinbo Li
- School of Public Health, Kunming Medical University, Kunming, China
| | - Le Cai
- School of Public Health, Kunming Medical University, Kunming, China
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Hossain A, Suhel SA, Chowdhury SR, Islam S, Akther N, Dhor NR, Hossain MZ, Hossain MA, Rahman SA. Hypertension and undiagnosed hypertension among Bangladeshi adults: Identifying prevalence and associated factors using a nationwide survey. Front Public Health 2022; 10:1066449. [PMID: 36561867 PMCID: PMC9763893 DOI: 10.3389/fpubh.2022.1066449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Background Although undiagnosed hypertension (HTN) is a serious concern worldwide, it is less of an importance in Bangladesh, where there is a dearth of research on the subject. So, we aimed to identify the prevalence and associated factors for diagnosed and undiagnosed HTN. Methods We analyzed the recent 2017-2018 Bangladesh Demographic and Health Survey data. We included 11,981 participants aged 18 years and above for the analysis. The prevalence rates of both diagnosed and undiagnosed hypertension were computed for all individuals and subgroups. The influence of socio-demographic, household, and community-related variables on HTN and undiagnosed HTN was investigated using multinomial regression analysis. Results The study finds 1,464 (12.2%) of the 11,981 respondents [6,815 females [56.9 %]; mean age 39.4 years] had diagnosed HTN, whereas 1 898 (15.8%) had undiagnosed HTN. The HTN and undiagnosed HTN were significantly prevalent in the elderly, type 2 diabetic (T2DM), and overweight and obese individuals. In terms of residential regions, people from coastal region had a significantly higher prevalence of both HTN (RRR: 1.37; 95% CI: 1.17-1.62) and undiagnosed HTN (RRR: 1.35; 95% CI: 1.17-1.56) compared to those from the central region of Bangladesh. Conclusions The high prevalence of undetected hypertension in Bangladesh suggests that screening procedures for the current chronic illness may be inadequate in routine clinical practice. All populations should have access to hypertension screening, but it is especially crucial for the elderly, those with diabetes, those who are overweight or obese, and those from coastal and northern regions of Bangladesh.
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Affiliation(s)
- Ahmed Hossain
- Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates,Department of Public Health, North South University, Dhaka, Bangladesh
| | | | - Saifur Rahman Chowdhury
- Department of Public Health, North South University, Dhaka, Bangladesh,Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada,*Correspondence: Saifur Rahman Chowdhury
| | - Shofiqul Islam
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Nayma Akther
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Nipa Rani Dhor
- Department of Public Health, North South University, Dhaka, Bangladesh
| | | | | | - Syed Azizur Rahman
- Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Cheng W, Du Y, Zhang Q, Wang X, He C, He J, Jing F, Ren H, Guo M, Tian J, Xu Z. Age-related changes in the risk of high blood pressure. Front Cardiovasc Med 2022; 9:939103. [PMID: 36187016 PMCID: PMC9521719 DOI: 10.3389/fcvm.2022.939103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background and aims Understanding the age-related trend of risk in high blood pressure (BP) is important for preventing heart failure and cardiovascular diseases. But such a trend is still underexplored. This study aims to (a) depict the relationship of BP patterns with age, and (b) understand the trend of high BP prevalence over time in different age groups. Materials and methods Health check-up data with an observational period of 8 years (January 1, 2011, to December 31, 2018) was used as the data source. A total of 71,468 participants aged over 18 years old with complete information on weight, height, age, gender, glucose, triglyceride, total cholesterol, systolic (SBP), and diastolic blood pressure (DBP) were included for analysis. Generalized additive models were adopted to explore the relationship between the risk of high BP and age. Variance analysis was conducted by testing the trend of high BP prevalence in age groups over time. Results Risk of high SBP showed a continuous rise from age 35 to 79 years and a concurrent early increase in the risk of high DBP; after age 50–65 years, high DBP risk declined. The risk of SBP rises linearly with age for men, whereas increases non-linearly for women. In addition, a significant increasing trend of high SBP risk among middle-aged people was found during the past decade, men experienced a later but longer period of increase in high SBP than women. Conclusion The high SBP risk progresses more rapidly in the early lifetime in women, compared to the lifetime thereafter. Thresholds of increasing trend of SBP suggest a possible need for hypertension screening in China after the age of 40.
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Affiliation(s)
- Weibin Cheng
- Department of Health Management, Guangdong Second Provincial General Hospital, Guangzhou, China
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
- School of Data Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yumeng Du
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Xin Wang
- School of Artificial Intelligence, Tianjin University, Tianjin, China
| | - Chaocheng He
- School of Information Management, Wuhan University, Wuhan, China
| | - Jingjun He
- Department of Health Management, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Fengshi Jing
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Hao Ren
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Mengzhuo Guo
- School of Data Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Junzhang Tian
- Department of Health Management, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Zhongzhi Xu
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
- School of Data Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Palomo-Piñón S, Antonio-Villa NE, García-Cortés LR, Álvarez-Aguilar C, González-Palomo E, Bertadillo-Mendoza OM, Figueroa-Suárez ME, Vargas-Hernández F, Herrera-Olvera IG, Cruz-Toledo JE, Cruz-Arce MA, Serafín-Méndez B, Muñoz-Cortés G, Morfin-Macias CJ. Prevalence and characterization of undiagnosed arterial hypertension in the eastern zone of Mexico. J Clin Hypertens (Greenwich) 2021; 24:131-139. [PMID: 34962058 PMCID: PMC8845470 DOI: 10.1111/jch.14414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/16/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022]
Abstract
Arterial hypertension is considered a public health problem with severe consequences at an individual and public health levels. However, there is a lack of information regarding its characterization in Mexico. The objective of this study is to estimate the proportion of undiagnosed arterial hypertension (UAH) and the overall prevalence and clinical management of arterial hypertension within the Eastern Zone of Mexico. Additionally, we explore associated factors related with both UAH and uncontrolled arterial hypertension. We obtained information from the May Measure Month (MMM) 2019 study. People were asked for cardiovascular risk factors and blood pressure was measured according to the protocols of the European Society of Hypertension (ESH). Data from 5901 subjects were extracted: 76.04% from the Eastern Zone of the State of Mexico. The overall prevalence of hypertension was 32.4% (95% CI 31.2-33.6). From all subjects living with hypertension, 28.3% had UAH, 22.1% had previous diagnosis but were untreated; 29.3% were treated but had uncontrolled hypertension. Younger men adults living in the State of Michoacán had increased proportion of UAH and untreated hypertension. We observed that male sex, age, obesity, living at Michoacán were risk factors for UAH. Finally, male sex, diabetes, and living at Michoacán were related risk conditions for having uncontrolled arterial hypertension. In summary, there is a high proportion of UAH in Easter Zone of Mexico. Younger adults had higher proportion of UAH and untreated hypertension profiles. Efficient actions are required to make a timely diagnosis in the young adult population to prevent long-term complications.
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Affiliation(s)
- Silvia Palomo-Piñón
- Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, México.,Programa de Posgrado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | - Luis Rey García-Cortés
- Coordinación Auxiliar Médica de Investigación en Salud, IMSS, Estado de México Oriente, México
| | - Cleto Álvarez-Aguilar
- Coordinación Auxiliar Médica de Investigación en Salud, IMSS, Morelia, Michoacán, México
| | | | | | - María Eugenia Figueroa-Suárez
- Coordinación Clínica de Educación e Investigación en Salud (CCEIS), Unidad de Medicina Familiar (UMF) No. 52, IMSS, Estado de México Oriente, México
| | | | | | | | - Maria Adriana Cruz-Arce
- CCEIS, Unidad Médica de Atención Ambulatoria con UMF No. 198, IMSS, Estado de México Oriente, México
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The effect of continuous Jue tone intervention on blood pressure and vasoactive substances in hypertensive rats with a liver-fire hyperactivity pattern. JOURNAL OF TRADITIONAL CHINESE MEDICAL SCIENCES 2021. [DOI: 10.1016/j.jtcms.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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