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Huang JF, Zhang DY, An DW, Li MX, Liu CY, Feng YQ, Zheng QD, Chen X, Staessen JA, Wang JG, Li Y. Efficacy of antihypertensive treatment for target organ protection in patients with masked hypertension (ANTI-MASK): a multicentre, double-blind, placebo-controlled trial. EClinicalMedicine 2024; 74:102736. [PMID: 39091669 PMCID: PMC11293515 DOI: 10.1016/j.eclinm.2024.102736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/21/2024] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
Background Masked hypertension is associated with target organ damage (TOD) and adverse health outcomes, but whether antihypertensive treatment improves TOD in patients with masked hypertension is unproven. Methods In this multicentre, randomised, double-blind, placebo-controlled trial at 15 Chinese hospitals, untreated outpatients aged 30-70 years with an office blood pressure (BP) of <140/<90 mm Hg and 24-h, daytime or nighttime ambulatory BP of ≥130/≥80, ≥135/≥85, or ≥120/≥70 mm Hg were enrolled. Patients had ≥1 sign of TOD: electrocardiographic left ventricular hypertrophy (LVH), brachial-ankle pulse wave velocity (baPWV) ≥1400 cm/s, or urinary albumin-to-creatinine ratio (ACR) ≥3.5 mg/mmol in women and ≥2.5 mg/mmol in men. Exclusion criteria included secondary hypertension, diabetic nephropathy, serum creatinine ≥176.8 μmol/L, and cardiovascular disease within 6 months of screening. After stratification for centre, sex and the presence of nighttime hypertension, eligible patients were randomly assigned (1:1) to receive antihypertensive treatment or placebo. Patients and investigators were masked to group assignment. Active treatment consisted of allisartan starting at 80 mg/day, to be increased to 160 mg/day at month 2, and to be combined with amlodipine 2.5 mg/day at month 4, if the ambulatory BP remained uncontrolled. Matching placebos were used likewise in the control group. The primary endpoint was the improvement of TOD, defined as normalisation of baPWV, ACR or LVH or a ≥20% reduction in baPWV or ACR over the 48-week follow-up. The intention-to-treat analysis included all randomised patients, the per-protocol analysis patients who fully adhered to the protocol, and the safety analysis all patients who received at least one dose of the study medication. This study is registered with ClinicalTrials.gov, NCT02893358. Findings Between February 14, 2017, and October 31, 2020, 320 patients (43.1% women; mean age ± SD 53.7 ± 9.7 years) were enrolled. Baseline office and 24-h BP averaged 130 ± 6.0/81 ± 5.9 mm Hg and 136 ± 8.6/84 ± 6.1 mm Hg, and the prevalence of elevated baPWV, ACR and LVH were 97.5%, 12.5%, and 7.8%, respectively. The 24-h BP decreased on average (±SE) by 10.1 ± 0.9/6.4 ± 0.5 mm Hg in 153 patients on active treatment and by 1.3 ± 0.9/1.0 ± 0.5 mm Hg in 167 patients on placebo. Improvement of TOD occurred in 79 patients randomised to active treatment and in 49 patients on placebo: 51.6% (95% CI 43.7%, 59.5%) versus 29.3% (22.1, 36.5%; p < 0.0001). Per-protocol and subgroup analyses were confirmatory. Adverse events were generally mild and occurred in 38 (25.3%) and 43 (26.4%) patients randomised to active treatment and placebo, respectively (p = 0.83). Interpretation Our results suggest that antihypertensive treatment improves TOD in patients with masked hypertension, highlighting the need of treatment. However, the long-term benefit in preventing cardiovascular complications still needs to be established. Funding Salubris China.
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Affiliation(s)
- Jian-Feng Huang
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiatong University School of Medicine, Shanghai, China
| | - Dong-Yan Zhang
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiatong University School of Medicine, Shanghai, China
| | - De-Wei An
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiatong University School of Medicine, Shanghai, China
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
| | - Ming-Xuan Li
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiatong University School of Medicine, Shanghai, China
| | - Chang-Yuan Liu
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiatong University School of Medicine, Shanghai, China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Provincial Peoples' Hospital, Guangzhou, Guangdong, China
| | - Qi-Dong Zheng
- Department of Internal Medicine, Yuhuan 2nd Peoples' Hospital, Taizhou City, Zhejiang Province, China
| | - Xin Chen
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiatong University School of Medicine, Shanghai, China
| | - Jan A. Staessen
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiatong University School of Medicine, Shanghai, China
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
- Biomedical Research Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiatong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiatong University School of Medicine, Shanghai, China
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Huang QF, Yang WY, Asayama K, Zhang ZY, Thijs L, Li Y, O’Brien E, Staessen JA. Ambulatory Blood Pressure Monitoring to Diagnose and Manage Hypertension. Hypertension 2021; 77:254-264. [PMID: 33390042 PMCID: PMC7803442 DOI: 10.1161/hypertensionaha.120.14591] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This review portrays how ambulatory blood pressure (BP) monitoring was established and recommended as the method of choice for the assessment of BP and for the rational use of antihypertensive drugs. To establish much-needed diagnostic ambulatory BP thresholds, initial statistical approaches evolved into longitudinal studies of patients and populations, which demonstrated that cardiovascular complications are more closely associated with 24-hour and nighttime BP than with office BP. Studies cross-classifying individuals based on ambulatory and office BP thresholds identified white-coat hypertension, an elevated office BP in the presence of ambulatory normotension as a low-risk condition, whereas its counterpart, masked hypertension, carries a hazard almost as high as ambulatory combined with office hypertension. What clinically matters most is the level of the 24-hour and the nighttime BP, while other BP indexes derived from 24-hour ambulatory BP recordings, on top of the 24-hour and nighttime BP level, add little to risk stratification or hypertension management. Ambulatory BP monitoring is cost-effective. Ambulatory and home BP monitoring are complimentary approaches. Their interchangeability provides great versatility in the clinical implementation of out-of-office BP measurement. We are still waiting for evidence from randomized clinical trials to prove that out-of-office BP monitoring is superior to office BP in adjusting antihypertensive drug treatment and in the prevention of cardiovascular complications. A starting research line, the development of a standardized validation protocol for wearable BP monitoring devices, might facilitate the clinical applicability of ambulatory BP monitoring.
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Affiliation(s)
- Qi-Fang Huang
- From the Department of Cardiovascular Medicine, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital (Q.-F.H., Y.L.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-Yi Yang
- Department of Cardiology, Shanghai General Hospital (W.-Y.Y), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A.)
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan (K.A.)
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (K.A., Z.-Y.Z., L.T., J.A.S)
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (K.A., Z.-Y.Z., L.T., J.A.S)
| | - Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (K.A., Z.-Y.Z., L.T., J.A.S)
| | - Yan Li
- From the Department of Cardiovascular Medicine, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital (Q.-F.H., Y.L.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Eoin O’Brien
- Conway Institute, University College Dublin, Ireland (E.O.B.)
| | - Jan A. Staessen
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (K.A., Z.-Y.Z., L.T., J.A.S)
- Research Institute Alliance for the Promotion of Preventive Medicine (www.appremed.org), Mechelen, Belgium (J.A.S)
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Wei FF, Zhang ZY, Thijs L, Yang WY, Jacobs L, Cauwenberghs N, Gu YM, Kuznetsova T, Allegaert K, Verhamme P, Li Y, Struijker-Boudier HAJ, Staessen JA. Conventional and Ambulatory Blood Pressure as Predictors of Retinal Arteriolar Narrowing. Hypertension 2016; 68:511-20. [PMID: 27324224 PMCID: PMC4956676 DOI: 10.1161/hypertensionaha.116.07523] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/22/2016] [Indexed: 01/07/2023]
Abstract
Supplemental Digital Content is available in the text. At variance with the long established paradigm that retinal arteriolar narrowing trails hypertension, several longitudinal studies, all based on conventional blood pressure (CBP) measurement, proposed that retinal arteriolar narrowing indicates heightened microvascular resistance and precedes hypertension. In 783 randomly recruited Flemish (mean age, 38.2 years; 51.3% women), we investigated to what extent CBP and daytime (10 am to 8 pm) ambulatory blood pressure (ABP) measured at baseline (1989–2008) predicted the central retinal arteriolar equivalent (CRAE) in retinal photographs obtained at follow-up (2008–2015). Systolic/diastolic hypertension thresholds were 140/90 mm Hg for CBP and 135/85 mm Hg for ABP. In multivariable-adjusted models including both baseline CBP and ABP, CRAE after 10.3 years (median) of follow-up was unrelated to CBP (P≥0.14), whereas ABP predicted CRAE narrowing (P≤0.011). Per 1-SD increment in systolic/diastolic blood pressure, the association sizes were −0.95 µm (95% confidence interval, −2.20 to 0.30)/−0.75 µm (−1.93 to 0.42) for CBP and −1.76 µm (−2.95 to −0.58)/−1.48 µm (−2.61 to −0.34) for ABP. Patients with ambulatory hypertension at baseline (17.0%) had smaller CRAE (146.5 versus 152.6 µm; P<0.001) at follow-up. CRAE was not different (P≥0.31) between true normotension (normal CBP and ABP; prevalence, 77.6%) and white-coat hypertension (elevated CBP and normal ABP, 5.4%) and between masked hypertension (normal CBP and elevated ABP, 10.2%) and hypertension (elevated CBP and ABP, 6.8%). In conclusion, the paradigm that retinal arteriolar narrowing precedes hypertension can be explained by the limitations of CBP measurement, including nonidentification of masked and white-coat hypertension.
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Affiliation(s)
- Fang-Fei Wei
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Zhen-Yu Zhang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Lutgarde Thijs
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Wen-Yi Yang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Lotte Jacobs
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Nicholas Cauwenberghs
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Yu-Mei Gu
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Tatiana Kuznetsova
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Karel Allegaert
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Peter Verhamme
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Yan Li
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Harry A J Struijker-Boudier
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands
| | - Jan A Staessen
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands.
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