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Juhanoja EP, Niiranen TJ, Johansson JK, Puukka PJ, Thijs L, Asayama K, Langén VL, Hozawa A, Aparicio LS, Ohkubo T, Tsuji I, Imai Y, Stergiou GS, Jula AM, Staessen JA. Outcome-Driven Thresholds for Increased Home Blood Pressure Variability. Hypertension 2017; 69:599-607. [PMID: 28193705 DOI: 10.1161/hypertensionaha.116.08603] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 11/26/2016] [Accepted: 11/29/2016] [Indexed: 11/16/2022]
Abstract
Increased blood pressure (BP) variability predicts cardiovascular disease, but lack of operational thresholds limits its use in clinical practice. Our aim was to define outcome-driven thresholds for increased day-to-day home BP variability. We studied a population-based sample of 6238 individuals (mean age 60.0±12.9, 56.4% women) from Japan, Greece, and Finland. All participants self-measured their home BP on ≥3 days. We defined home BP variability as the coefficient of variation of the first morning BPs on 3 to 7 days. We assessed the association between systolic/diastolic BP variability (as a continuous variable and in deciles of coefficient of variation) and cardiovascular outcomes using Cox regression models adjusted for cohort and classical cardiovascular risk factors, including BP. During a follow-up of 9.3±3.6 years, 304 cardiovascular deaths and 715 cardiovascular events occurred. A 1 SD increase in systolic/diastolic home BP variability was associated with increased risk of cardiovascular mortality (hazard ratio, 1.17/1.22; 95% confidence interval, 1.06-1.30/1.11-1.34; P=0.003/<0.0001) and cardiovascular events (hazard ratio, 1.13/1.14; 95% confidence interval, 1.05-1.21/1.07-1.23; P=0.0007/0.0002). Compared with the average risk in the whole population, risk of cardiovascular deaths (hazard ratio, 1.66/1.84; 95% confidence interval, 1.27-2.17/1.42-2.37; P=0.0002/<0.0001) and events (hazard ratio, 1.46/1.42; 95% confidence interval, 1.21-1.76/1.17-1.71; P<0.0001/0.0004) was increased in the highest decile of systolic/diastolic BP variability (coefficient of variation>11.0/12.8). Increased home BP variability predicts cardiovascular outcomes in the general population. Individuals with a systolic/diastolic coefficient of variation of day-to-day home BP >11.0/12.8 may have an increased risk of cardiovascular disease. These findings could help physicians identify individuals who are at an increased cardiovascular disease risk.
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Affiliation(s)
- Eeva P Juhanoja
- From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.).
| | - Teemu J Niiranen
- From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.)
| | - Jouni K Johansson
- From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.)
| | - Pauli J Puukka
- From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.)
| | - Lutgarde Thijs
- From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.)
| | - Kei Asayama
- From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.)
| | - Ville L Langén
- From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.)
| | - Atsushi Hozawa
- From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.)
| | - Lucas S Aparicio
- From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.)
| | - Takayoshi Ohkubo
- From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.)
| | - Ichiro Tsuji
- From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.)
| | - Yutaka Imai
- From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.)
| | - George S Stergiou
- From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.)
| | - Antti M Jula
- From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.)
| | - Jan A Staessen
- From the Department of Health, National Institute for Health and Welfare, Turku, Finland (E.P.J., T.J.N., J.K.J., P.J.P., V.L.L., A.M.J.); Division of Medicine (E.P.J.) and Heart Centre (V.L.L.), Turku University Hospital, Finland; Department of Medicine, University of Turku, Finland (E.P.J., A.M.J.); Framingham Heart Study, Boston University, MA (T.J.N.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan (A.H.); Hospital Italiano de Buenos Aires, Argentina (L.S.A.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.); and R&D VitaK Group, Maastricht University, The Netherlands (J.A.S.)
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