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Walther LM, Wirtz PH. Physiological reactivity to acute mental stress in essential hypertension-a systematic review. Front Cardiovasc Med 2023; 10:1215710. [PMID: 37636310 PMCID: PMC10450926 DOI: 10.3389/fcvm.2023.1215710] [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: 05/02/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Objective Exaggerated physiological reactions to acute mental stress (AMS) are associated with hypertension (development) and have been proposed to play an important role in mediating the cardiovascular disease risk with hypertension. A variety of studies compared physiological reactivity to AMS between essential hypertensive (HT) and normotensive (NT) individuals. However, a systematic review of studies across stress-reactive physiological systems including intermediate biological risk factors for cardiovascular diseases is lacking. Methods We conducted a systematic literature search (PubMed) for original articles and short reports, published in English language in peer-reviewed journals in November and December 2022. We targeted studies comparing the reactivity between essential HT and NT to AMS in terms of cognitive tasks, public speaking tasks, or the combination of both, in at least one of the predefined stress-reactive physiological systems. Results We included a total of 58 publications. The majority of studies investigated physiological reactivity to mental stressors of mild or moderate intensity. Whereas HT seem to exhibit increased reactivity in response to mild or moderate AMS only under certain conditions (i.e., in response to mild mental stressors with specific characteristics, in an early hyperkinetic stage of HT, or with respect to certain stress systems), increased physiological reactivity in HT as compared to NT to AMS of strong intensity was observed across all investigated stress-reactive physiological systems. Conclusion Overall, this systematic review supports the proposed and expected generalized physiological hyperreactivity to AMS with essential hypertension, in particular to strong mental stress. Moreover, we discuss potential underlying mechanisms and highlight open questions for future research of importance for the comprehensive understanding of the observed hyperreactivity to AMS in essential hypertension.
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Affiliation(s)
- Lisa-Marie Walther
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany
- Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Konstanz, Germany
| | - Petra H. Wirtz
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany
- Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Konstanz, Germany
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2
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Gideon A, Sauter C, Fieres J, Berger T, Renner B, Wirtz PH. Kinetics and Interrelations of the Renin Aldosterone Response to Acute Psychosocial Stress: A Neglected Stress System. J Clin Endocrinol Metab 2020; 105:5618777. [PMID: 31711229 PMCID: PMC7034950 DOI: 10.1210/clinem/dgz190] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/07/2019] [Indexed: 12/18/2022]
Abstract
CONTEXT The renin-angiotensin-aldosterone system (RAAS) plays an important role in cardiovascular homeostasis and its dysfunction relates to negative health consequences. Acute psychosocial stress seems to activate the RAAS in humans, but stress kinetics and interrelations of RAAS parameters compared with a nonstress control group remain inconclusive. OBJECTIVE We systematically investigated in a randomized placebo-controlled design stress kinetics and interrelations of the reactivity of RAAS parameters measured in plasma and saliva to standardized acute psychosocial stress induction. METHODS 58 healthy young men were assigned to either a stress or a placebo control group. The stress group underwent the Trier Social Stress Test (TSST), while the control group underwent the placebo TSST. We repeatedly assessed plasma renin, and plasma and salivary aldosterone before and up to 3 hours after stress/placebo. We simultaneously assessed salivary cortisol to validate successful stress induction and to test for interrelations. RESULTS Acute psychosocial stress induced significant increases in all endocrine measures compared with placebo-stress (all P ≤ .041). Highest renin levels were observed 1 minute after stress, and highest aldosterone and cortisol levels 10 and 20 minutes after stress, with salivary aldosterone starting earlier at 1 minute after stress. Renin completed recovery at 10 minutes, cortisol at 60 minutes, salivary aldosterone at 90 minutes, and plasma aldosterone at 180 minutes after stress. Stress increase scores of all endocrine measures related to each other, as did renin and cortisol areas under the curve with respect to increase (AUCi) and salivary and plasma aldosterone AUCi (all P ≤ .047). CONCLUSIONS Our findings suggest that in humans acute psychosocial stress induces a differential and interrelated RAAS parameter activation pattern. Potential implications for stress-related cardiovascular risk remain to be elucidated.
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Affiliation(s)
- Angelina Gideon
- Biological Work and Health Psychology, University of Konstanz, Germany
| | - Christine Sauter
- Biological Work and Health Psychology, University of Konstanz, Germany
| | - Judy Fieres
- Biological Work and Health Psychology, University of Konstanz, Germany
| | - Thilo Berger
- Biological Work and Health Psychology, University of Konstanz, Germany
| | - Britta Renner
- Health Psychology, University of Konstanz, Germany
- Centre for the Advanced Study of Collective Behavior, University of Konstanz, Germany
| | - Petra H Wirtz
- Biological Work and Health Psychology, University of Konstanz, Germany
- Centre for the Advanced Study of Collective Behavior, University of Konstanz, Germany
- Correspondence and Reprint Requests: Petra H. Wirtz, PhD, Biological Work and Health Psychology, University of Konstanz Universitaetsstrasse 10, 78457 Konstanz, Germany. E-mail:
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3
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Mann SJ. Neurogenic hypertension: pathophysiology, diagnosis and management. Clin Auton Res 2018; 28:363-374. [DOI: 10.1007/s10286-018-0541-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/19/2018] [Indexed: 02/07/2023]
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4
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Abstract
Although "labile hypertension" is regularly encountered by clinicians, there is a paucity of information available to guide therapeutic decisions. This review discusses its clinical relevance, the limitations of current knowledge, and possible directions for future research and clinical management. Results of studies that assessed measures of blood pressure variability or reactivity are reviewed. The limited information about effects of antihypertensive drugs on blood pressure variability is discussed. Two different clinical presentations are differentiated: labile hypertension and paroxysmal hypertension. Labile hypertension remains a clinical impression without defined criteria or treatment guidance. Paroxysmal hypertension, also called pseudopheochromocytoma, presents as dramatic episodes of abrupt and severe blood pressure elevation. The disorder can be disabling. Although it regularly raises suspicion of a pheochromocytoma, such a tumor is found in <2 % of patients. The cause, which involves both emotional factors and the sympathetic nervous system, and treatment approaches, are presented.
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Affiliation(s)
- Samuel J Mann
- Division of Nephrology and Hypertension, NY-Presbyterian Hospital-Weill Cornell Medical College, 424 East 70th St, New York, NY, 10021, USA.
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5
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Mann SJ. Psychosomatic research in hypertension: the lack of impact of decades of research and new directions to consider. J Clin Hypertens (Greenwich) 2012; 14:657-64. [PMID: 23031141 DOI: 10.1111/j.1751-7176.2012.00686.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Samuel J Mann
- Division of Nephrology and Hypertension, Department of Medicine, Weill/Cornell Medical Center, New York Presbyterian Hospital, New York, NY 10021,USA.
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6
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Mayorov DN. Brain angiotensin AT1 receptors as specific regulators of cardiovascular reactivity to acute psychoemotional stress. Clin Exp Pharmacol Physiol 2011; 38:126-35. [PMID: 21143493 DOI: 10.1111/j.1440-1681.2010.05469.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
1. Cardiovascular reactivity, an abrupt rise in blood pressure (BP) and heart rate in response to psychoemotional stress, is a risk factor for heart disease. Pharmacological and molecular genetic studies suggest that brain angiotensin (Ang) II and AT(1) receptors are required for the normal expression of sympathetic cardiovascular responses to various psychological stressors. Moreover, overactivity of the brain AngII system may contribute to enhanced cardiovascular reactivity in hypertension. 2. Conversely, brain AT(1) receptors appear to be less important for the regulation of sympathetic cardiovascular responses to a range of stressors involving an immediate physiological threat (physical stressors) in animal models. 3. Apart from threatening events, appetitive stimuli can induce a distinct, central nervous system-mediated rise in BP. However, evidence indicates that brain AT(1) receptors are not essential for the regulation of cardiovascular arousal associated with positively motivated behaviour, such as anticipation and the consumption of palatable food. The role of central AT(1) receptors in regulating cardiovascular activation elicited by other types of appetitive stimuli remains to be determined. 4. Emerging evidence also indicates that brain AT(1) receptors play a limited role in the regulation of cardiovascular responses to non-emotional natural daily activities, sleep and exercise. 5. Collectively, these findings suggest that, with respect to cardiovascular arousal, central AT(1) receptors may be involved primarily in the regulation of the defence response. Therefore, these receptors could be a potential therapeutic target for selective attenuation of BP hyperreactivity to aversive stressors, without altering physiologically important cardiovascular adjustments to normal daily activities, sleep and exercise.
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Affiliation(s)
- Dmitry N Mayorov
- Department of Pharmacology, University of Melbourne, Melbourne, Victoria, Australia.
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Mann SJ. Drug Therapy for Resistant Hypertension: Simplifying the Approach. J Clin Hypertens (Greenwich) 2010; 13:120-30. [DOI: 10.1111/j.1751-7176.2010.00387.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Abstract
J Clin Hypertens (Greenwich). 2009;11:491-497. (c)2009 Wiley Periodicals, Inc.Although the management of the labile component of blood pressure elevation is a problem often encountered by clinicians, there is a paucity of information available to guide therapeutic decisions. This review discusses the clinical relevance of blood pressure lability, the limitations of current knowledge, and possible directions for future research and clinical management.
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Affiliation(s)
- Samuel J Mann
- Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital, Weill/Cornell Medical Center, New York, NY 10021, USA.
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Mann SJ. Combined alpha/beta-blockade: an underused approach to the treatment of resistant hypertension. J Clin Hypertens (Greenwich) 2007; 9:663-6. [PMID: 17786066 PMCID: PMC8110083 DOI: 10.1111/j.1524-6175.2007.07225.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
In this study, we examined the role of angiotensin type 1 (AT1) receptors in the rostral ventrolateral medulla (RVLM) in mediating the pressor action of emotional stress in conscious rabbits. Rabbits were chronically instrumented with guide cannulas for bilateral microinjections into the RVLM and an electrode for measuring renal sympathetic nerve activity (RSNA). Airjet stress evoked increases in arterial pressure, heart rate, and RSNA, which reached a maximum (+9+/-1 mm Hg, +20+/-5 beats/min, and +93+/-17%, respectively) in the first 2 minutes of stress exposure. Then RSNA rapidly returned to prestress values, while arterial pressure and heart rate remained close to the maximal level until the conclusion of the 7-minute airjet exposure. Microinjections of the nonselective angiotensin receptor antagonist sarile (0.5 nmol, n=8) or AT1 receptor antagonists losartan (2 nmol, n=6) or candesartan (0.2 nmol, n=6) into the RVLM did not alter resting cardiovascular parameters. By contrast, the antagonists attenuated the sustained phase (4 to 7 minutes) of the pressor stress response by 55% to 89%. However, only sarile decreased the onset of this response. The antagonists affected neither the stress-induced tachycardia nor the pressor response to glutamate microinjections. Microinfusion of angiotensin II (4 pmol/min, n=8) into the RVLM did not change the pressor response to airjet stress but attenuated tachycardic response by 47%. Microinjections of vehicle did not alter the cardiovascular stress response. Sarile, losartan, and angiotensin II did not affect the sympathoexcitatory response to baroreceptor unloading. These results suggest that AT1 receptors in the RVLM are important in mediating the pressor effects of emotional stress in conscious rabbits.
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Affiliation(s)
- Dmitry N Mayorov
- Baker Heart Research Institute, PO Box 6492, St Kilda Rd Central, Melbourne, Victoria 8008, Australia.
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Allen K, Shykoff BE, Izzo JL. Pet Ownership, but Not ACE Inhibitor Therapy, Blunts Home Blood Pressure Responses to Mental Stress. Hypertension 2001. [DOI: 10.1161/hyp.38.4.815] [Citation(s) in RCA: 206] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the present study, we evaluated the effect of a nonevaluative social support intervention (pet ownership) on blood pressure response to mental stress before and during ACE inhibitor therapy. Forty-eight hypertensive individuals participated in an experiment at home and in the physician’s office. Participants were randomized to an experimental group with assignment of pet ownership in addition to lisinopril (20 mg/d) or to a control group with only lisinopril (20 mg/d). On each study day, blood pressure, heart rate, and plasma renin activity were recorded at baseline and after each mental stressor (serial subtraction and speech). Before drug therapy, mean responses to mental stress did not differ significantly between experimental and control groups in heart rate (94 [SD 6.8] versus 93 [6.8] bpm), systolic blood pressure (182 [8.0] versus 181 [8.3] mm Hg), diastolic blood pressure (120 [6.6] versus 119 [7.9] mm Hg), or plasma renin activity (9.4 [0.59] versus 9.3 [0.57] ng · mL
−1
· h
−1
). Lisinopril therapy lowered resting blood pressure by ≈35/20 mm Hg in both groups, but responses to mental stress were significantly lower among pet owners relative to those who only received lisinopril (
P
<0.0001; heart rate 81 [6.3] versus 91 [6.5] bpm, systolic blood pressure 131 [6.8] versus 141 [7.8] mm Hg, diastolic blood pressure 92 [6.3] versus 100 [6.8] mm Hg, and plasma renin activity 13.9 [0.92] versus 16.1 [0.58] ng · mL
−1
· h
−1
). We conclude that ACE inhibitor therapy alone lowers resting blood pressure, whereas increased social support through pet ownership lowers blood pressure response to mental stress.
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Affiliation(s)
- Karen Allen
- From the Division of Clinical Pharmacology, Department of Medicine, State University of New York at Buffalo
| | - Barbara E. Shykoff
- From the Division of Clinical Pharmacology, Department of Medicine, State University of New York at Buffalo
| | - Joseph L. Izzo
- From the Division of Clinical Pharmacology, Department of Medicine, State University of New York at Buffalo
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Le Pailleur C, Vacheron A, Landais P, Mounier-Véhier C, Feder JM, Montgermont P, Jais JP, Metzger JP. Talking effect and white coat phenomenon in hypertensive patients. Behav Med 1996; 22:114-22. [PMID: 9116382 DOI: 10.1080/08964289.1996.9933772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Both white coat effect (the tendency of blood pressure to rise during a medical visit) and talking effect were analyzed in 42 patients with essential hypertension. Blood pressure was measured during the clinic visit and over the subsequent 24-hour ambulatory period, with the physician performing 49 +/- 4 measurements for each patient. Three silent periods and two talking periods (stress and relaxation) were randomly allocated in a crossover design and studied, using analysis of variance. During the initial 11-minute silent period, systolic/diastolic blood pressures increased by 6 mm Hg/5 mm Hg. During the subsequent talking periods, these variations were significantly greater: +22 mm Hg/+17 mm Hg. Measures of systolic/diastolic blood pressure were higher during stressful talking than during relaxed talking. The talking and its emotional contents seemed to explain 70% of the white coat phenomenon. To minimize the white coat phenomenon in the clinic, physicians, nurses, and clinicians are advised to measure blood pressure during an initial period of silence.
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Affiliation(s)
- C Le Pailleur
- Clinique Cardiologique, Hôpital Necker, Paris, France
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14
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Mann SJ. Severe paroxysmal hypertension. An automatic syndrome and its relationship to repressed emotions. PSYCHOSOMATICS 1996; 37:444-50. [PMID: 8824124 DOI: 10.1016/s0033-3182(96)71532-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In most patients with severe and symptomatic paroxysmal hypertension, a pheochromocytoma or other medical cause is rarely identified. This article presents the psychosocial assessment of 10 such patients, in whom the absence of any emotional distress preceding paroxysms had discouraged consideration of any psychological basis. However, a causative role of repressed unreported emotions was strongly suggested by 1) a history of unusually severe emotional trauma in 8 of 10 patients, 2) the absence of feelings related to the trauma, and 3) the prompt and sustained response of 3 patients to psychotherapeutic or psychopharmacologic intervention. These observations suggest that some cases of unexplained paroxysmal hypertension have a psychosomatic etiology and result from repressed rather than perceived and reported emotions. Treatment options are explored.
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Affiliation(s)
- S J Mann
- Hypertension Center, New York Hospital-Cornell Medical Center, NY 10021, USA
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Abstract
To examine the role of stress on renal sodium excretion, we studied 27 normotensive and 21 hypertensive subjects. All subjects were placed on a standardized sodium diet. After water loading (2290 ml in 3 1/2 hr) they completed a 30 min baseline and a 30 min stress period (competitive videogame). Sixty-nine percent of the subjects increased ("excreters") and 31% decreased ("retainers") their sodium excretion under stress. In addition to increased potassium excretion (p < 0.006), excreters also manifested less of a stress associated increase in systolic (p = 0.055) and diastolic (p = 0.040) blood pressure and showed greater expression of anger (p < 0.02) than retainers. The same subjects were also studied to determin the effects of angiotensin converting enzyme inhibition (captopril 25 mg b.i.d.) on sodium excretion. On captopril, excreters now showed a retention of sodium (p < 0.001) and potassium (p < 0.01) under stress and no longer differed significantly in blood pressure reactivity. The results suggest that there are two different stress-related patterns of renal sodium excretion, that these patterns are related to blood pressure responses to stress, and may be related to anger expression. In addition, sodium excretion patterns under stress may be altered with certain type of antihypertensive medications.
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Affiliation(s)
- J D Rollnik
- Department of Medical Psychology, Ruhr-University of Bochum, Germany
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Cardillo C, Mores N, Motolese M, Folli G. Effects of benazepril on stress testing blood pressure in essential hypertension. Am J Cardiol 1994; 73:368-73. [PMID: 8109551 DOI: 10.1016/0002-9149(94)90010-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The effects of different doses of the angiotensin-converting enzyme inhibitor benazepril on cardiovascular response to a set of standardized laboratory tasks were analyzed. Eighteen patients (15 men and 3 women) with mild-to-moderate essential hypertension were randomly allocated to receive 10 or 20 mg of benazepril, or placebo, each administered once daily for 2 weeks, according to a double-blind, 3-period design. At the end of each treatment period, patients were examined at resting baseline and while performing mental arithmetic, handgrip and cycle ergometry tests. In comparison with placebo, the average reductions in resting systolic blood pressure (BP) were 8.7 mm Hg (95% confidence intervals [CI] -15.2 to -2.1) with 10 mg of benazepril, and 7.8 mm Hg (95% CI -14.4 to -1.3) with 20 mg; the corresponding reductions in resting diastolic BP were 5.1 mm Hg (95% CI -8.7 to -1.4) and 6.8 mm Hg (95% CI -10.4 to -3.1) (all p < 0.05). During mental arithmetic, the reductions in systolic BP were 10.4 mm Hg (95% CI -17.4 to -3.4) with 10 mg of benazepril, and 13.8 mm Hg (95% CI -20.8 to -6.8) with 20 mg; diastolic BP was reduced by 4.5 mm Hg (95% CI -8.5 to -0.5) and 8.3 mm Hg (95% CI -13.2 to -4.3), respectively (all p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C Cardillo
- Istituto di Patologia Medica, Università Cattolica del Sacro Cuore, Roma, Italy
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