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Publications (10 of 49) Show all publications
Charchar, F. J., Prestes, P. R., Mills, C., Ching, S. M., Neupane, D., Marques, F. Z., . . . Tomaszewski, M. (2024). Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension. Journal of Hypertension, 42(1), 23-49
Open this publication in new window or tab >>Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension
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2024 (English)In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 42, no 1, p. 23-49Article in journal (Refereed) Published
Abstract [en]

Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools.

Place, publisher, year, edition, pages
Wolters Kluwer, 2024
Keywords
Blood pressure, hypertension, lifestyle, holistic approach, nutrition, diet, exercise, mindfulness, obesity, pollution
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-218141 (URN)10.1097/HJH.0000000000003563 (DOI)37712135 (PubMedID)2-s2.0-85174338943 (Scopus ID)
Available from: 2023-12-15 Created: 2023-12-15 Last updated: 2023-12-15Bibliographically approved
Shimanda, P. P., Shumba, T. W., Brunström, M., Iipinge, S. N., Söderberg, S., Lindholm, L. & Norström, F. (2024). Preventive interventions to reduce the burden of rheumatic heart disease in populations at risk: a systematic review. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 13(5), Article ID e032442.
Open this publication in new window or tab >>Preventive interventions to reduce the burden of rheumatic heart disease in populations at risk: a systematic review
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2024 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 13, no 5, article id e032442Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Rheumatic heart disease (RHD) is a devastating yet preventable condition that disproportionately affects low-middle-income countries and indigenous populations in some high-income countries. Various preventive interventions have been implemented across the globe, but evidence for the effectiveness of these measures in reducing the incidence or prevalence of acute rheumatic fever and RHD is scattered. This systematic review aims to assess the effectiveness of preventive interventions and identify the strategies used to reduce the burden of RHD.

METHODS AND RESULTS: A comprehensive search was conducted to identify relevant studies on RHD prevention interventions including interventions for primordial, primary, and secondary prevention. Effectiveness measures for the interventions were gathered when available. The findings indicate that school-based primary prevention services targeting the early detection and treatment of Group A Streptococcus pharyngitis infection with penicillin have the potential to reduce the incidence of Group A Streptococcus pharyngitis and acute rheumatic fever. Community-based programs using various prevention strategies also reduced the burden of RHD. However, there is limited evidence from low-middle-income countries and a lack of rigorous evaluations reporting the true impact of the interventions. Narrative synthesis was performed, and the methodological quality appraisal was done using the Joanna Briggs Institute critical appraisal tools.

CONCLUSIONS: This systematic review underscores the importance of various preventive interventions in reducing the incidence and burden of Group A Streptococcus pharyngitis, acute rheumatic fever, and RHD. Rigorous evaluations and comprehensive analyses of interventions are necessary for guiding effective strategies and informing public health policies to prevent and reduce the burden of these diseases in diverse populations.

REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42020170503.

Place, publisher, year, edition, pages
American Heart Association, 2024
Keywords
RHD prevention, acute rheumatic fever, rheumatic heart disease, systematic review
National Category
Health Sciences Public Health, Global Health, Social Medicine and Epidemiology
Research subject
cardiovascular disease; Public health; Epidemiology
Identifiers
urn:nbn:se:umu:diva-221473 (URN)10.1161/JAHA.123.032442 (DOI)38390809 (PubMedID)2-s2.0-85187199895 (Scopus ID)
Funder
Familjen Erling-Perssons Stiftelse
Available from: 2024-02-23 Created: 2024-02-23 Last updated: 2024-04-02Bibliographically approved
Mancia, G., Brunström, M., Burnier, M., Grassi, G., Januszewicz, A., Muiesan, M. L., . . . Kreutz, R. (2024). Rationale of treatment recommendations in the 2023 ESH hypertension guidelines. European journal of internal medicine
Open this publication in new window or tab >>Rationale of treatment recommendations in the 2023 ESH hypertension guidelines
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2024 (English)In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828Article in journal (Refereed) Epub ahead of print
Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Guidelines
National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-220167 (URN)10.1016/j.ejim.2023.12.015 (DOI)38216445 (PubMedID)2-s2.0-85182628598 (Scopus ID)
Available from: 2024-02-05 Created: 2024-02-05 Last updated: 2024-02-05
Eklund, S., Israelsson, H., Brunström, M., Forsberg, K. & Malm, J. (2023). 10-year mortality, causes of death and cardiovascular comorbidities in idiopathic normal pressure hydrocephalus. Journal of Neurology
Open this publication in new window or tab >>10-year mortality, causes of death and cardiovascular comorbidities in idiopathic normal pressure hydrocephalus
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2023 (English)In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: The objective was to investigate 10-year mortality, causes of death and cardiovascular comorbidity in idiopathic normal pressure hydrocephalus (iNPH) and to evaluate their mutual associations.

Methods: This prospective cohort study included 176 CSF-shunted iNPH patients, and 368 age- and sex-matched controls. At inclusion, participants were medically examined, had blood analyzed and answered a questionnaire. The vascular comorbidities investigated were smoking, diabetes, body mass index, blood pressure (BP), hyperlipidemia, kidney function, atrial fibrillation and, cerebro- and cardiovascular disease.

Results: Survival was observed for a mean period of 10.3 ± 0.84 years. Shunted iNPH patients had an increased risk of death compared to controls (hazard ratio (HR) = 2.5, 95% CI 1.86–3.36; p < 0.001). After 10 years, 50% (n = 88) of iNPH patients and 24% (n = 88) of the controls were dead (p < 0.001). The risk of dying from cardiovascular disease, falls and neurological diseases were higher in iNPH (p < 0.05). The most common cause of death in iNPH was cardiovascular diseases (14% vs 7% for controls). Seven out of nine iNPH dying from falls had subdural hematomas. Systolic BP (HR = 0.985 95% CI 0.972–0.997, p = 0.018), atrial fibrillation (HR = 2.652, 95% CI 1.506–4.872, p < 0.001) and creatinine (HR = 1.018, 95% CI 1.010–1.027, p < 0.001) were independently associated with mortality for iNPH.

Discussion: This long-term and population-matched cohort study indicates that in spite of CSF-shunt treatment, iNPH has shorter life expectancy. It may be important to treat iNPH in supplementary ways to reduce mortality. Both cardiovascular comorbidities and lethal falls are contributing to the excess mortality in iNPH and reducing these preventable risks should be an established part of the treatment plan.

Place, publisher, year, edition, pages
Springer Science+Business Media B.V., 2023
Keywords
Cardiovascular disease, Causes of death, Comorbidities, Mortality, Normal pressure hydrocephalus
National Category
Neurology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-216638 (URN)10.1007/s00415-023-12067-5 (DOI)2-s2.0-85175579237 (Scopus ID)
Funder
Region Västerbotten
Available from: 2023-11-14 Created: 2023-11-14 Last updated: 2023-11-15
Mancia, G., Kreutz, R., Brunström, M., Burnier, M., Grassi, G., Januszewicz, A., . . . Kjeldsen, S. E. (2023). 2023 ESH guidelines for the management of arterial hypertension the task force for the management of arterial hypertension of the European society of hypertension: endorsed by the international society of hypertension (ISH) and the European renal association (ERA). Journal of Hypertension, 41(12), 1874-2071
Open this publication in new window or tab >>2023 ESH guidelines for the management of arterial hypertension the task force for the management of arterial hypertension of the European society of hypertension: endorsed by the international society of hypertension (ISH) and the European renal association (ERA)
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2023 (English)In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 41, no 12, p. 1874-2071Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Wolters Kluwer, 2023
Keywords
antihypertensive device interventions, antihypertensive drug therapy, blood pressure, cardiac disease, cardiovascular disease, drug combinations, guidelines, heart failure, hypertension, kidney disease, lifestyle interventions, patient’s follow-up, organ damage, secondary hypertension, stroke
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-216659 (URN)10.1097/HJH.0000000000003480 (DOI)37345492 (PubMedID)2-s2.0-85175741837 (Scopus ID)
Available from: 2023-11-28 Created: 2023-11-28 Last updated: 2023-11-28Bibliographically approved
Rietz, H., Pennlert, J., Nordström, P. & Brunström, M. (2023). Blood pressure level in late adolescence and risk for cardiovascular events: a cohort study. Annals of Internal Medicine, 176(10), 1289-1298
Open this publication in new window or tab >>Blood pressure level in late adolescence and risk for cardiovascular events: a cohort study
2023 (English)In: Annals of Internal Medicine, ISSN 0003-4819, E-ISSN 1539-3704, Vol. 176, no 10, p. 1289-1298Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Not enough is known about the association between blood pressure (BP) in adolescence and future cardiovascular events.

OBJECTIVE: To measure this association using the 2017 American College of Cardiology/American Heart Association guidelines for classifying BP elevation.

DESIGN: Cohort study.Sweden.

PARTICIPANTS: Males in late adolescence who were conscripted into the military from 1969 to 1997.

MEASUREMENTS: Baseline BP was measured at conscription. The primary outcome was a composite of cardiovascular death or first hospitalization for myocardial infarction, heart failure, ischemic stroke, or intracerebral hemorrhage.

RESULTS: The study included 1 366 519 males with a mean age of 18.3 years. The baseline BP was classified as elevated (120 to 129/<80 mm Hg) for 28.8% of participants and hypertensive (≥130/80 mm Hg) for 53.7%. During a median follow-up of 35.9 years, 79 644 had a primary outcome. The adjusted hazard ratio was 1.10 for elevated BP (95% CI, 1.07 to 1.13), 1.15 for stage 1 isolated systolic hypertension (ISH) (CI, 1.11 to 1.18), 1.23 for stage 1 isolated diastolic hypertension (IDH) (CI, 1.18 to 1.28), 1.32 for stage 1 systolic-diastolic hypertension (SDH) (CI, 1.27 to 1.37), 1.31 for stage 2 ISH (CI, 1.28 to 1.35), 1.55 for stage 2 IDH (CI, 1.42 to 1.69), and 1.71 for stage 2 SDH (CI, 1.58 to 1.84). The cumulative risk for cardiovascular events also increased gradually across BP stages, ranging from 14.7% for normal BP to 24.3% for stage 2 SDH at age 68 years.

LIMITATION: This was an observational study of Swedish men.

CONCLUSION: Increasing BP levels in late adolescence are associated with gradually increasing risks for major cardiovascular events, beginning at a BP level of 120/80 mm Hg.

Place, publisher, year, edition, pages
American College of Physicians, 2023
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-216130 (URN)10.7326/M23-0112 (DOI)001077947700001 ()37748180 (PubMedID)2-s2.0-85174751634 (Scopus ID)
Funder
Västerbotten County CouncilSwedish Society for Medical Research (SSMF)
Available from: 2023-11-06 Created: 2023-11-06 Last updated: 2023-11-06Bibliographically approved
Johansson, C., Örtendahl, L., Lind, M. M., Andersson, J., Johansson, L. & Brunström, M. (2023). Diabetes, prediabetes, and atrial fibrillation: a population-based cohort study based on national and regional registers. Journal of Internal Medicine, 294(5), 605-615
Open this publication in new window or tab >>Diabetes, prediabetes, and atrial fibrillation: a population-based cohort study based on national and regional registers
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2023 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 294, no 5, p. 605-615Article in journal (Refereed) Published
Abstract [en]

Background: Previous studies have shown an increased risk for atrial fibrillation and atrial flutter (AF) in people with type 2 diabetes and prediabetes. It is unclear whether this increase in AF risk is independent of other risk factors for AF.

Objective: To investigate the association between diabetes and different prediabetic states, as independent risk factors for the onset of AF.

Methods: We performed a population-based cohort study in Northern Sweden, including data on fasting plasma glucose, oral glucose tolerance test, major cardiovascular risk factors, medical history, and lifestyle factors. Participants were divided into six groups depending on glycemic status and followed through national registers for AF diagnosis. Cox proportional hazard model was used to assess the association between glycemic status and AF, using normoglycemia as reference.

Results: The cohort consisted of 88,889 participants who underwent a total of 139,661 health examinations. In the model adjusted for age and sex, there was a significant association between glycemic status and development of AF in all groups except the impaired glucose tolerance group, with the strongest association for the group with known diabetes (p-value <0.001). In a model adjusted for sex, age, systolic blood pressure, body mass index, antihypertensive drugs, cholesterol, alcohol, smoking, education level, marital status, and physical activity, there was no significant association between glycemic status and AF.

Conclusions/interpretation: The association between glycemic status and AF disappears upon adjustment for potential confounders. Diabetes and prediabetes do not appear to be independent risk factors for AF.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
atrial fibrillation, diabetes, glucose, oral glucose tolerance test, prediabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-212329 (URN)10.1111/joim.13688 (DOI)37387643 (PubMedID)2-s2.0-85164804333 (Scopus ID)
Funder
Region VästerbottenUmeå University
Available from: 2023-07-25 Created: 2023-07-25 Last updated: 2024-04-08Bibliographically approved
Brunström, M., Carlberg, B. & Kjeldsen, S. E. (2023). Effect of antihypertensive treatment in isolated systolic hypertension (ISH): systematic review and meta-analysis of randomised controlled trials. Blood Pressure, 32(1), Article ID 2226757.
Open this publication in new window or tab >>Effect of antihypertensive treatment in isolated systolic hypertension (ISH): systematic review and meta-analysis of randomised controlled trials
2023 (English)In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 32, no 1, article id 2226757Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Isolated systolic hypertension (ISH) in middle-aged and elderly is associated with high cardiovascular risk, but no randomised controlled trial has assessed the effect of antihypertensive treatment in ISH using today's definition, i.e. systolic blood pressure (SBP) ≥140 mmHg and diastolic blood pressure (DBP) <90 mmHg.

METHODS: A systematic review and meta-analysis of randomised controlled trials was performed. Studies with ≥1000 patient-years of follow-up, comparing more intensive versus less intensive BP targets, or active drug versus placebo, were included if the mean baseline SBP was ≥140 mmHg and the mean baseline DBP was <90 mmHg. The primary outcome was major adverse cardiovascular events (MACE). Relative risks from each trial were pooled in random-effects meta-analyses, stratified by baseline and attained SBP level.

RESULTS: Twenty-four trials, including 113,105 participants (mean age 67 years; mean blood pressure 149/83 mmHg) were included in the analysis. Overall, treatment reduced the risk of MACE by 9% (relative risk 0.91, 95% confidence interval 0.88-0.93). Treatment was more effective if baseline SBP was ≥160 mmHg (RR 0.77, 95% CIs 0.70-0.86) compared to 140-159 mmHg (RR 0.92, 95% CIs 0.89-0.95; p = 0.002 for interaction), but provided equal additional benefit across all attained SBP levels (RR 0.80, 95% CIs 0.70-0.92 for <130 mmHg, RR 0.92, 95% CIs 0.89-0.96 for 130-139 mmHg, and RR 0.87, 95% CIs 0.82-0.93 for ≥140 mmHg; p = 0.070 for interaction).

CONCLUSIONS: These findings support antihypertensive treatment of isolated systolic hypertension, regardless of baseline SBP, to target SBP <140 mmHg and even <130 mmHg if well tolerated.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2023
Keywords
antihypertensive treatment, blood pressure goal, blood pressure target, elderly, Isolated systolic hypertension
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-212065 (URN)10.1080/08037051.2023.2226757 (DOI)001018684900001 ()37395100 (PubMedID)2-s2.0-85163615143 (Scopus ID)
Available from: 2023-07-18 Created: 2023-07-18 Last updated: 2023-07-18Bibliographically approved
Brunström, M., Ng, N., Dahlström, J., Lindholm, L. H., Norberg, M., Nyström, L., . . . Carlberg, B. (2022). Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease. Blood Pressure, 31(1), 31-39
Open this publication in new window or tab >>Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease
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2022 (English)In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 31, no 1, p. 31-39Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Education and feedback on hypertension management has been associated with improved hypertension control. This study aimed to assess the effectiveness of such interventions to reduce the risk of stroke and cardiovascular events. MATERIALS AND METHODS: Individuals ≥18 years with a blood pressure (BP) recording in Västerbotten or Södermanland County during the study period 2001 to 2009 were included in 108 serial cohort studies, each with 24 months follow-up. The primary outcome was risk of first-ever stroke in Västerbotten County (intervention) compared with Södermanland County (control). Secondary outcomes were first-ever major adverse cardiovascular event (MACE), myocardial infarction, and heart failure, as well as all-cause and cardiovascular mortality. All outcomes were analysed using time-to-event data included in a Cox proportional hazards model adjusted for age, sex, hypertension, diabetes, coronary artery disease, atrial fibrillation, systolic BP at inclusion, marital status, and disposable income. RESULTS: A total of 121 365 individuals (mean [SD] age at inclusion 61.7 [16.3] years; 59.9% female; mean inclusion BP 142.3/82.6 mmHg) in the intervention county were compared to 131 924 individuals (63.6 [16.2] years; 61.2% female; 144.1/81.1 mmHg) in the control county. A first-ever stroke occurred in 2 823 (2.3%) individuals in the intervention county, and 3 584 (2.7%) individuals in the control county (adjusted hazard ratio 0.96, 95% CI 0.90 to 1.03). No differences were observed for MACE, myocardial infarction or heart failure, whereas all-cause mortality (HR 0.91, 95% CI 0.87 to 0.95) and cardiovascular mortality (HR 0.91, 95% CI 0.85 to 0.98) were lower in the intervention county. CONCLUSIONS: This study does not support an association between education and feedback on hypertension management to primary care physicians and the risk for stroke or cardiovascular outcomes. The observed differences for mortality outcomes should be interpreted with caution.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2022
Keywords
antihypertensive treatment, continuous medical education, Hypertension, implementation science, primary care
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-192773 (URN)10.1080/08037051.2022.2041393 (DOI)000757622100001 ()35179089 (PubMedID)2-s2.0-85124775764 (Scopus ID)
Funder
Swedish Research Council, K2007-70X-20515-01-2Swedish Research Council, K2009-69X-20515-04-2Swedish Research Council, 2017-02246Västerbotten County CouncilSwedish Society for Medical Research (SSMF)
Available from: 2022-03-09 Created: 2022-03-09 Last updated: 2023-05-22Bibliographically approved
Stergiou, G., Brunström, M., MacDonald, T., Kyriakoulis, K. G., Bursztyn, M., Khan, N., . . . Tomaszewski, M. (2022). Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension. Journal of Hypertension, 40(10), 1847-1858
Open this publication in new window or tab >>Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension
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2022 (English)In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 40, no 10, p. 1847-1858Article, review/survey (Refereed) Published
Abstract [en]

Antihypertensive drug therapy is one of the most efficient medical interventions for preventing disability and death globally. Most of the evidence supporting its benefits has been derived from outcome trials with morning dosing of medications. Accumulating evidence suggests an adverse prognosis associated with night-time hypertension, nondipping blood pressure (BP) profile and morning BP surge, with increased incidence of cardiovascular events during the first few morning hours. These observations provide justification for complete 24-h BP control as being the primary goal of antihypertensive treatment. Bedtime administration of antihypertensive drugs has also been proposed as a potentially more effective treatment strategy than morning administration. This Position Paper by the International Society of Hypertension reviewed the published evidence on the clinical relevance of the diurnal variation in BP and the timing of antihypertensive drug treatment, aiming to provide consensus recommendations for clinical practice. Eight published outcome hypertension studies involved bedtime dosing of antihypertensive drugs, and all had major methodological and/or other flaws and a high risk of bias in testing the impact of bedtime compared to morning treatment. Three ongoing, well designed, prospective, randomized controlled outcome trials are expected to provide high-quality data on the efficacy and safety of evening or bedtime versus morning drug dosing. Until that information is available, preferred use of bedtime drug dosing of antihypertensive drugs should not be routinely recommended in clinical practice. Complete 24-h control of BP should be targeted using readily available, long-acting antihypertensive medications as monotherapy or combinations administered in a single morning dose.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2022
Keywords
ambulatory blood pressure monitoring, antihypertensive drugs, bedtime administration, chronotherapy, dipper, nocturnal blood pressure, systematic review
National Category
Cardiac and Cardiovascular Systems Pharmacology and Toxicology
Identifiers
urn:nbn:se:umu:diva-199387 (URN)10.1097/HJH.0000000000003240 (DOI)000848743000005 ()35983870 (PubMedID)2-s2.0-85137137234 (Scopus ID)
Available from: 2022-10-03 Created: 2022-10-03 Last updated: 2023-05-22Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-7054-0905

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