Publications
104 results found
Khanji MY, Collett G, Godec T, et al., 2023, Improved lifestyle is associated with improved depression, anxiety and well-being over time in UK healthcare professionals during the COVID-19 pandemic: insights from the CoPE-HCP cohort study, GENERAL PSYCHIATRY, Vol: 36, ISSN: 2096-5923
Kapil V, Collett G, Godec T, et al., 2022, Longitudinal comparisons of mental health, burnout and well-being in patient-facing, non-patient-facing, healthcare professionals and non-healthcare professionals during the COVID-19 pandemic: findings from the CoPE-HCP study, BJPSYCH OPEN, Vol: 8, ISSN: 2056-4724
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- Citations: 1
Collaborat CTTC, Reith C, Baigent C, et al., 2022, Effect of statin therapy on muscle symptoms: an individual participant data meta-analysis of large-scale, randomised, double-blind trials, LANCET, Vol: 400, Pages: 832-845, ISSN: 0140-6736
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- Citations: 12
Nazarzadeh M, Bidel Z, Canoy D, et al., 2022, Blood pressure-lowering treatment for prevention of major cardiovascular diseases in people with and without type 2 diabetes: an individual participant-level data meta-analysis, The Lancet Diabetes and Endocrinology, Vol: 10, Pages: 645-654, ISSN: 2213-8595
BACKGROUND: Controversy exists as to whether the threshold for blood pressure-lowering treatment should differ between people with and without type 2 diabetes. We aimed to investigate the effects of blood pressure-lowering treatment on the risk of major cardiovascular events by type 2 diabetes status, as well as by baseline levels of systolic blood pressure. METHODS: We conducted a one-stage individual participant-level data meta-analysis of major randomised controlled trials using the Blood Pressure Lowering Treatment Trialists' Collaboration dataset. Trials with information on type 2 diabetes status at baseline were eligible if they compared blood pressure-lowering medications versus placebo or other classes of blood pressure-lowering medications, or an intensive versus a standard blood pressure-lowering strategy, and reported at least 1000 persons-years of follow-up in each group. Trials exclusively on participants with heart failure or with short-term therapies and acute myocardial infarction or other acute settings were excluded. We expressed treatment effect per 5 mm Hg reduction in systolic blood pressure on the risk of developing a major cardiovascular event as the primary outcome, defined as the first occurrence of fatal or non-fatal stroke or cerebrovascular disease, fatal or non-fatal ischaemic heart disease, or heart failure causing death or requiring hospitalisation. Cox proportional hazard models, stratified by trial, were used to estimate hazard ratios (HRs) separately by type 2 diabetes status at baseline, with further stratification by baseline categories of systolic blood pressure (in 10 mm Hg increments from <120 mm Hg to ≥170 mm Hg). To estimate absolute risk reductions, we used a Poisson regression model over the follow-up duration. The effect of each of the five major blood pressure-lowering drug classes, including angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, β blockers, calcium channel blockers, and th
Maniero C, Lopuszko A, Papalois KB, et al., 2022, Non-pharmacological factors for hypertension management: a systematic review of international guidelines, EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, ISSN: 2047-4873
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- Citations: 3
Kottke TE, Gupta AK, Thomas RJ, 2022, Failing Cardiovascular Health A Population Code Blue, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 80, Pages: 152-154, ISSN: 0735-1097
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- Citations: 1
Oggero S, Godec T, van Gorp R, et al., 2022, Role of plasma extracellular vesicles in prediction of cardiovascular risk and alterations in response to statin therapy in hypertensive patients., Journal of Hypertension, Vol: 40, ISSN: 0263-6352
BACKGROUND: Rapid and accurate new biomarkers to predict risk of cardiovascular disease (CVD) are essential. The utility of extracellular vesicles in predicting the CVD risk is postulated, yet it remains unknown whether their expression is altered in response to statin therapy. METHODS: We performed in-vitro studies with human umbilical vein endothelial cells (HUVEC) and vascular smooth muscle cells (hVSMC), and conducted a nested case-control study (nCCS) in hypertensive patients (n = 40) randomized to either atorvastatin or placebo in the ASCOT-LLA. Cases had a major adverse cardiovascular event or death (MACE) during 3.5 years of follow-up (median) from the time of extracellular vesicle characterization while controls, matched for age and duration of treatment, remained event-free. Conditional logistic regression models determined the risk of MACE. Additionally, the relationship of extracellular vesicle levels with statin therapy was assessed. RESULTS: Added to HUVEC, extracellular vesicles increased neutrophil recruitment, and to hVSMC, aggravated calcification and proliferation. In the nCCS, compared with controls, cases (i.e. with MACE) had preceding higher levels of CD14+ and CD14+/CD41+ extracellular vesicles (P = 0.009 and P = 0.012, respectively) and a significant reduction in the median size of the vesicles (P = 0.037). On matched analysis, higher CD14+ extracellular vesicles were associated with a 3.7-fold increased risk of MACE (P = 0.032). Patients treated with atorvastatin (vs. placebo) had both reduced size of extracellular vesicles and the proportion of CD146+ extracellular vesicles (P = 0.034 and P = 0.020, respectively). CONCLUSION AND RELEVANCE: These pilot analyses suggest a mechanistic role for extracellular vesicles in the development of CVD, with significant and differential changes in extracellular vesicles amongst those at risk of MACE, and those on atorvastatin therapy.
George M, Gupta A, 2022, Blood pressure-lowering effects of Omega-3 polyunsaturated fatty acids: are these the missing link to explain the relationship between Omega-3 polyunsaturated fatty acids and cardiovascular disease?, Journal of the American Heart Association, Vol: 11, Pages: 1-4, ISSN: 2047-9980
Ng SM, Pan J, Mouyis K, et al., 2022, Quantifying the excess risk of adverse COVID-19 outcomes in unvaccinated individuals with diabetes mellitus, hypertension, ischaemic heart disease or myocardial injury: a meta-analysis, Frontiers in Cardiovascular Medicine, Vol: 9, Pages: 1-12, ISSN: 2297-055X
Background: More than 80% of individuals in low and middle-income countries (LMICs) are unvaccinated against coronavirus disease 2019 (COVID-19). In contrast, the greatest burden of cardiovascular disease is seen in LMIC populations. Hypertension (HTN), diabetes mellitus (DM), ischaemic heart disease (IHD) and myocardial injury have been variably associated with adverse COVID-19 outcomes. A systematic comparison of their impact on specific COVID-19 outcomes is lacking. We quantified the impact of DM, HTN, IHD and myocardial injury on six adverse COVID-19 outcomes: death, acute respiratory distress syndrome (ARDS), invasive mechanical ventilation (IMV), admission to intensive care (ITUadm), acute kidney injury (AKI) and severe COVID-19 disease (SCov), in an unvaccinated population.Methodology: We included studies published between 1st December 2019 and 16th July 2020 with extractable data on patients ≥18 years of age with suspected or confirmed SARS-CoV-2 infection. Odds ratios (OR) for the association between DM, HTN, IHD and myocardial injury with each of six COVID-19 outcomes were measured.Results: We included 110 studies comprising 48,809 COVID-19 patients. Myocardial injury had the strongest association for all six adverse COVID-19 outcomes [death: OR 8.85 95% CI (8.08–9.68), ARDS: 5.70 (4.48–7.24), IMV: 3.42 (2.92–4.01), ITUadm: 4.85 (3.94–6.05), AKI: 10.49 (6.55–16.78), SCov: 5.10 (4.26–6.05)]. HTN and DM were also significantly associated with death, ARDS, ITUadm, AKI and SCov. There was substantial heterogeneity in the results, partly explained by differences in age, gender, geographical region and recruitment period.Conclusion: COVID-19 patients with myocardial injury are at substantially greater risk of death, severe disease and other adverse outcomes. Weaker, yet significant associations are present in patients with HTN, DM and IHD. Quantifying these associations is important for risk stratification, resource allocat
Ng SM, Pan J, Gupta AK, 2022, Poor achievement of lipid targets after acute coronary syndrome: what can we improve?, MEDICAL JOURNAL OF AUSTRALIA, Vol: 216, Pages: 458-459, ISSN: 0025-729X
Boulestreau R, van den Born B-JH, Lip GYH, et al., 2022, Malignant Hypertension: Current Perspectives and Challenges, JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol: 11
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- Citations: 5
Canoy D, Copland E, Nazarzadeh M, et al., 2022, Antihypertensive drug effects on long-term blood pressure: an individual-level data meta-analysis of randomised clinical trials, HEART, Vol: 108, Pages: 1281-1289, ISSN: 1355-6037
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- Citations: 8
Gee LC, Massimo G, Lau C, et al., 2021, Inorganic nitrate attenuates cardiac dysfunction: roles for xanthine oxidoreductase and nitric oxide, BRITISH JOURNAL OF PHARMACOLOGY, Vol: 179, Pages: 4757-4777, ISSN: 0007-1188
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- Citations: 1
Whiteley WN, Gupta AK, Godec T, et al., 2021, Long-Term Incidence of Stroke and Dementia in ASCOT, STROKE, Vol: 52, Pages: 3088-3096, ISSN: 0039-2499
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- Citations: 2
Rahimi K, Bidel Z, Nazarzadeh M, et al., 2021, Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis, The Lancet, Vol: 398, Pages: 1053-1064, ISSN: 0140-6736
BackgroundThe effects of pharmacological blood-pressure-lowering on cardiovascular outcomes in individuals aged 70 years and older, particularly when blood pressure is not substantially increased, is uncertain. We compared the effects of blood-pressure-lowering treatment on the risk of major cardiovascular events in groups of patients stratified by age and blood pressure at baseline.MethodsWe did a meta-analysis using individual participant-level data from randomised controlled trials of pharmacological blood-pressure-lowering versus placebo or other classes of blood-pressure-lowering medications, or between more versus less intensive treatment strategies, which had at least 1000 persons-years of follow-up in each treatment group. Participants with previous history of heart failure were excluded. Data were obtained from the Blood Pressure Lowering Treatment Triallists' Collaboration. We pooled the data and categorised participants into baseline age groups (<55 years, 55–64 years, 65–74 years, 75–84 years, and ≥85 years) and blood pressure categories (in 10 mm Hg increments from <120 mm Hg to ≥170 mm Hg systolic blood pressure and from <70 mm Hg to ≥110 mm Hg diastolic). We used a fixed effects one-stage approach and applied Cox proportional hazard models, stratified by trial, to analyse the data. The primary outcome was defined as either a composite of fatal or non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring hospital admission.FindingsWe included data from 358 707 participants from 51 randomised clinical trials. The age of participants at randomisation ranged from 21 years to 105 years (median 65 years [IQR 59–75]), with 42 960 (12·0%) participants younger than 55 years, 128 437 (35·8%) aged 55–64 years, 128 506 (35·8%) 65–74 years, 54 016 (15·1%) 75–84 years, and
Chong JH, Chahal CAA, Gupta A, et al., 2021, COVID-19 and the Digitalisation of Cardiovascular Training and Education-A Review of Guiding Themes for Equitable and Effective Post-graduate Telelearning, FRONTIERS IN CARDIOVASCULAR MEDICINE, Vol: 8, ISSN: 2297-055X
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- Citations: 3
Gupta AK, 2021, JAHA Spotlight on Air Pollution and Cardiovascular Disease: A Call for Urgent Action, JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol: 10, ISSN: 2047-9980
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- Citations: 1
Rahimi K, 2021, Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis, The Lancet, Vol: 397, Pages: 1625-1636, ISSN: 0140-6736
BackgroundThe effects of pharmacological blood pressure lowering at normal or high-normal blood pressure ranges in people with or without pre-existing cardiovascular disease remains uncertain. We analysed individual participant data from randomised trials to investigate the effects of blood pressure lowering treatment on the risk of major cardiovascular events by baseline levels of systolic blood pressure.MethodsWe did a meta-analysis of individual participant-level data from 48 randomised trials of pharmacological blood pressure lowering medications versus placebo or other classes of blood pressure-lowering medications, or between more versus less intensive treatment regimens, which had at least 1000 persons-years of follow-up in each group. Trials exclusively done with participants with heart failure or short-term interventions in participants with acute myocardial infarction or other acute settings were excluded. Data from 51 studies published between 1972 and 2013 were obtained by the Blood Pressure Lowering Treatment Trialists' Collaboration (Oxford University, Oxford, UK). We pooled the data to investigate the stratified effects of blood pressure-lowering treatment in participants with and without prevalent cardiovascular disease (ie, any reports of stroke, myocardial infarction, or ischaemic heart disease before randomisation), overall and across seven systolic blood pressure categories (ranging from <120 to ≥170 mm Hg). The primary outcome was a major cardiovascular event (defined as a composite of fatal and non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring admission to hospital), analysed as per intention to treat.FindingsData for 344 716 participants from 48 randomised clinical trials were available for this analysis. Pre-randomisation mean systolic/diastolic blood pressures were 146/84 mm Hg in participants with previous cardiovascular disease (n=157 728) and 157/89 mm
Copland E, Canoy D, Nazarzadeh M, et al., 2021, Antihypertensive treatment and risk of cancer: an individual participant data meta-analysis, The Lancet Oncology, Vol: 22, Pages: 558-570, ISSN: 1213-9432
BackgroundSome studies have suggested a link between antihypertensive medication and cancer, but the evidence is so far inconclusive. Thus, we aimed to investigate this association in a large individual patient data meta-analysis of randomised clinical trials.MethodsWe searched PubMed, MEDLINE, The Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from Jan 1, 1966, to Sept 1, 2019, to identify potentially eligible randomised controlled trials. Eligible studies were randomised controlled trials comparing one blood pressure lowering drug class with a placebo, inactive control, or other blood pressure lowering drug. We also required that trials had at least 1000 participant years of follow-up in each treatment group. Trials without cancer event information were excluded. We requested individual participant data from the authors of eligible trials. We pooled individual participant-level data from eligible trials and assessed the effects of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), β blockers, calcium channel blockers, and thiazide diuretics on cancer risk in one-stage individual participant data and network meta-analyses. Cause-specific fixed-effects Cox regression models, stratified by trial, were used to calculate hazard ratios (HRs). The primary outcome was any cancer event, defined as the first occurrence of any cancer diagnosed after randomisation. This study is registered with PROSPERO (CRD42018099283).Findings33 trials met the inclusion criteria, and included 260 447 participants with 15 012 cancer events. Median follow-up of included participants was 4·2 years (IQR 3·0–5·0). In the individual participant data meta-analysis comparing each drug class with all other comparators, no associations were identified between any antihypertensive drug class and risk of any cancer (HR 0·99 [95% CI 0·95–1·04] for ACEIs; 0·96 [0·92&nda
Khanji MY, Maniero C, NG S, et al., 2021, Early and Mid-Term Implications of the COVID-19 Pandemic on the Physical, Behavioral and Mental Health of Healthcare Professionals: The CoPE-HCP Study Protocol, FRONTIERS IN PSYCHOLOGY, Vol: 12, ISSN: 1664-1078
Siddiqui I, Aurelio M, Gupta A, et al., 2021, COVID-19: Causes of anxiety and wellbeing support needs of healthcare professionals in the UK: A cross-sectional survey, CLINICAL MEDICINE, Vol: 21, Pages: 66-72, ISSN: 1470-2118
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- Citations: 22
Rathod KS, Jones DA, Jain AK, et al., 2021, The influence of biological age and sex on long-term outcome after percutaneous coronary intervention for ST-elevation myocardial infarction, AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE, Vol: 11, Pages: 659-+, ISSN: 2160-200X
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- Citations: 1
Simon MA, Ahmad F, Eitzman DT, et al., 2020, Equity, Diversity, and Inclusiveness in Cardiovascular Medicine and Health Care, JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol: 9
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- Citations: 2
London B, 2020, Diversity, Equity, and Inclusiveness in Medicine and Cardiology, JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol: 9
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- Citations: 2
Gupta AK, Jneid H, Addison D, et al., 2020, Current perspectives on coronavirus disease 2019 and cardiovascular disease: a white paper by the JAHA editors, Journal of the American Heart Association, Vol: 9, Pages: 1-23, ISSN: 2047-9980
Coronavirus Disease 2019 (COVID‐19) has infected more than 3.0 million people worldwide and killed more than 200,000 as of April 27, 2020. In this White Paper, we address the cardiovascular co‐morbidities of COVID‐19 infection; the diagnosis and treatment of standard cardiovascular conditions during the pandemic; and the diagnosis and treatment of the cardiovascular consequences of COVID‐19 infection. In addition, we will also address various issues related to the safety of healthcare workers and the ethical issues related to patient care in this pandemic.
Kapil V, Gupta AK, 2020, Solar UV Radiation: A Potential Modifiable Risk Factor for Hypertension, JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol: 9, ISSN: 2047-9980
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- Citations: 4
Cabrera CP, Ng FL, Nicholls HL, et al., 2019, Over 1000 genetic loci influencing blood pressure with multiple systems and tissues implicated, Human Molecular Genetics, Vol: 28, Pages: R151-R161, ISSN: 0964-6906
High blood pressure (BP) remains the major heritable and modifiable risk factor for cardiovascular disease. Persistent high BP, or hypertension, is a complex trait with both genetic and environmental interactions. Despite swift advances in genomics, translating new discoveries to further our understanding of the underlying molecular mechanisms remains a challenge. More than 500 loci implicated in the regulation of BP have been revealed by genome-wide association studies (GWAS) in 2018 alone, taking the total number of BP genetic loci to over 1000. Even with the large number of loci now associated to BP, the genetic variance explained by all loci together remains low (~5.7%). These genetic associations have elucidated mechanisms and pathways regulating BP, highlighting potential new therapeutic and drug repurposing targets. A large proportion of the BP loci were discovered and reported simultaneously by multiple research groups, creating a knowledge gap, where the reported loci to date have not been investigated in a harmonious way. Here, we review the BP-associated genetic variants reported across GWAS studies and investigate their potential impact on the biological systems using in silico enrichment analyses for pathways, tissues, gene ontology and genetic pleiotropy.
Berkelmans GFN, Gudbjornsdottir S, Visseren FLJ, et al., 2019, Prediction of individual life-years gained without cardiovascular events from lipid, blood pressure, glucose, and aspirin treatment based on data of more than 500 000 patients with Type 2 diabetes mellitus, European Heart Journal, Vol: 40, Pages: 2899-2906, ISSN: 0195-668X
AimsAlthough group-level effectiveness of lipid, blood pressure, glucose, and aspirin treatment for prevention of cardiovascular disease (CVD) has been proven by trials, important differences in absolute effectiveness exist between individuals. We aim to develop and validate a prediction tool for individualizing lifelong CVD prevention in people with Type 2 diabetes mellitus (T2DM) predicting life-years gained without myocardial infarction or stroke.Methods and resultsWe developed and validated the Diabetes Lifetime-perspective prediction (DIAL) model, consisting of two complementary competing risk adjusted Cox proportional hazards functions using data from people with T2DM registered in the Swedish National Diabetes Registry (n = 389 366). Competing outcomes were (i) CVD events (vascular mortality, myocardial infarction, or stroke) and (ii) non-vascular mortality. Predictors were age, sex, smoking, systolic blood pressure, body mass index, haemoglobin A1c, estimated glomerular filtration rate, non- high-density lipoprotein cholesterol, albuminuria, T2DM duration, insulin treatment, and history of CVD. External validation was performed using data from the ADVANCE, ACCORD, ASCOT and ALLHAT-LLT-trials, the SMART and EPIC-NL cohorts, and the Scottish diabetes register (total n = 197 785). Predicted and observed CVD-free survival showed good agreement in all validation sets. C-statistics for prediction of CVD were 0.83 (95% confidence interval: 0.83–0.84) and 0.64–0.65 for internal and external validation, respectively. We provide an interactive calculator at www.U-Prevent.com that combines model predictions with relative treatment effects from trials to predict individual benefit from preventive treatment.ConclusionCardiovascular disease-free life expectancy and effects of lifelong prevention in terms of CVD-free life-years gained can be estimated for people with T2DM using readily available clinical characteristics. Predictions
MANIERO C, GUPTA AK, LOBO MD, 2019, Impact of the new ACC/AHA and ESC/ESH hypertension guidelines in the UK, European Heart Journal, Vol: 40, Pages: 2472-2475, ISSN: 0195-668X
Poulter NR, Dolan E, Gupta AK, et al., 2019, Efficacy and safety of incremental dosing of a new single-pill formulation of perindopril and amlodipine in the management of hypertension, American Journal of Cardiovascular Drugs, Vol: 19, Pages: 313-323, ISSN: 1175-3277
BACKGROUND: Angiotensin-converting enzyme inhibitors and calcium channel blockers in combination are widely recommended in hypertension guidelines. The advantages of single-pill combinations (SPCs) are increasingly recognized, so a dosage-adapted combination of perindopril and amlodipine was developed for the initial management of hypertension. OBJECTIVE: This randomized trial evaluated the blood pressure (BP)-lowering efficacy of four incremental doses of perindopril/amlodipine SPC in adults with mild-to-severe hypertension. METHODS: Eligible patients (N = 1617) were randomized to SPC perindopril 3.5 mg/amlodipine 2.5 mg (i.e., 3.5/2.5 mg) daily, uptitrating as required on a monthly basis up to 14/10 mg until BP < 140/90 mmHg (< 130/80 mmHg in patients with diabetes). The primary endpoint (proportion with controlled BP at each uptitrated dose) was evaluated at 6 months, and safety was evaluated at 9 months; 24-h ambulatory BP measurement and BP variability were also investigated. Control-arm participants (n = 1653) were randomized to irbesartan 150 mg daily, uptitrating over 3 months to irbesartan/hydrochlorothiazide 300/25 mg. RESULTS: Significant increases in BP control were observed with each dosage increment of perindopril/amlodipine, which was well tolerated, rising from 21% (3.5/2.5 mg) to 30% (7/5 mg), 37% (14/5 mg), and 42% (14/10 mg) after 1, 2, 3, and 6 months, respectively. Reductions in mean systolic and diastolic BP occurred with each incremental dose of perindopril/amlodipine. After 6 months, mean BP had fallen by 24.8/10.8 mmHg. Irbesartan-based therapy reduced clinic and 24-h BP similarly to perindopril/amlodipine, but perindopril/amlodipine reduced BP variability more in comparison. CONCLUSIONS: Incremental uptitration with dosage-adapted perindopril/amlodipine SPC is a safe and effective strategy for mana
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