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Current Hypertension Reports

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01.01.2018 | Hypertension and Emergency Medicine (T Rainer and P Levy, Section Editors)

Sympathomimetic Toxidromes and Other Pharmacological Causes of Acute Hypertension

verfasst von: Andrew King, Mirjana Dimovska, Luke Bisoski

Erschienen in: Current Hypertension Reports | Ausgabe 1/2018

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Abstract

Purpose of Review

Acute drug-induced hypertension, sympathomimetic toxicity, and other hyperadrenergic states can be caused by both xenobiotic toxicity and withdrawal. This manuscript is a selective review of the recent literature regarding pharmacologic causes of hypertensive emergencies and other hyperadrenergic states.

Recent Findings

We will discuss designer stimulants, alpha₂ and baclofen agonist withdrawal, and the clinical entity known as posterior reversible encephalopathy syndrome (PRES). Additionally, we examine the controversial “unopposed alpha” phenomenon which may result from use of beta-adrenergic antagonist in the presence of stimulant toxicity.

Summary

These topics encompass clinical situations and disease entities that are increasingly encountered and are often either unanticipated or under-recognized.

•• Hill SL, Thomas SH. Clinical toxicology of newer recreational drugs. Clin Toxicol (Phila). 2011;49(8):705–19. Recent extensive review of available information on synthetic “designer” drugs utilizing peer-reviewed literature to date as well as media and drug user forums, books, and government publications. https://doi.org/10.3109/15563650.2011.615318.CrossRef

Baumann MH, et al. Effects of “Legal X” piperazine analogs on dopamine and serotonin release in rat brain. Ann N Y Acad Sci. 2004;1025(1):189–97. https://doi.org/10.1196/annals.1316.024.CrossRefPubMed

Schep LJ, et al. The clinical toxicology of the designer “party pills” benzylpiperazine and trifluoromethylphenylpiperazine. Clin Toxicol (Phila). 2011;49(3):131–41. https://doi.org/10.3109/15563650.2011.572076.CrossRef

Cho, A.K. and D.S. Segal, Amphetamine and its analogs : psychopharmacology, toxicology, and abuse. 1994, San Diego: Academic Press. xxi, 503 p.

Villalobos CA, et al. 4-Bromo-2,5-dimethoxyphenethylamine (2C-B) and structurally related phenylethylamines are potent 5-HT2A receptor antagonists in Xenopus laevis oocytes. Br J Pharmacol. 2004;141(7):1167–74. https://doi.org/10.1038/sj.bjp.0705722.CrossRefPubMedPubMedCentral

Acuna-Castillo C, et al. Differences in potency and efficacy of a series of phenylisopropylamine/phenylethylamine pairs at 5-HT(2A) and 5-HT(2C) receptors. Br J Pharmacol. 2002;136(4):510–9. https://doi.org/10.1038/sj.bjp.0704747.CrossRefPubMedPubMedCentral

Wood DM, et al. Delayed onset of seizures and toxicity associated with recreational use of Bromo-dragonFLY. J Med Toxicol. 2009;5(4):226–9. https://doi.org/10.1007/BF03178273.CrossRefPubMedPubMedCentral

Meltzer PC, et al. 1-(4-Methylphenyl)-2-pyrrolidin-1-yl-pentan-1-one (Pyrovalerone) analogues: a promising class of monoamine uptake inhibitors. J Med Chem. 2006;49(4):1420–32. https://doi.org/10.1021/jm050797a.CrossRefPubMedPubMedCentral

Bowen JS, et al. Diffuse vascular spasm associated with 4-bromo-2,5-dimethoxyamphetamine ingestion. JAMA. 1983;249(11):1477–9. https://doi.org/10.1001/jama.1983.03330350053028.CrossRefPubMed

10.

Balikova M. Nonfatal and fatal DOB (2,5-dimethoxy-4-bromoamphetamine) overdose. Forensic Sci Int. 2005;153(1):85–91. https://doi.org/10.1016/j.forsciint.2005.04.022.CrossRefPubMed

11.

Andreasen MF, et al. A fatal poisoning involving Bromo-dragonfly. Forensic Sci Int. 2009;183(1–3):91–6. https://doi.org/10.1016/j.forsciint.2008.11.001.CrossRefPubMed

12.

Thorlacius K, Borna C, Personne M. Bromo-dragon fly—life-threatening drug. Can cause tissue necrosis as demonstrated by the first described case. Lakartidningen. 2008;105(16):1199–200.PubMed

13.

Lamberth PG, Ding GK, Nurmi LA. Fatal paramethoxy-amphetamine (PMA) poisoning in the Australian Capital Territory. Med J Aust. 2008;188(7):426.PubMed

14.

Carmo H, et al. CYP2D6 increases toxicity of the designer drug 4-methylthioamphetamine (4-MTA). Toxicology. 2007;229(3):236–44. https://doi.org/10.1016/j.tox.2006.10.024.CrossRefPubMed

15.

Levine M, Levitan R, Skolnik A. Compartment syndrome after “bath salts” use: a case series. Ann Emerg Med. 2013;61(4):480–3. https://doi.org/10.1016/j.annemergmed.2012.11.021.CrossRefPubMed

16.

Elliott S, Smith C. Investigation of the first deaths in the United Kingdom involving the detection and quantitation of the piperazines BZP and 3-TFMPP. J Anal Toxicol. 2008;32(2):172–7. https://doi.org/10.1093/jat/32.2.172.CrossRefPubMed

17.

Gee P, Jerram T, Bowie D. Multiorgan failure from 1-benzylpiperazine ingestion—legal high or lethal high? Clin Toxicol (Phila). 2010;48(3):230–3. https://doi.org/10.3109/15563651003592948.CrossRef

18.

Gee P, et al. Toxic effects of BZP-based herbal party pills in humans: a prospective study in Christchurch, New Zealand. N Z Med J. 2005;118(1227):U1784.PubMed

19.

Austin H, Monasterio E. Acute psychosis following ingestion of “Rapture”. Australas Psychiatry. 2004;12(4):406–8. https://doi.org/10.1080/j.1440-1665.2004.02137.x.PubMed

20.

Thompson I, et al. Randomised double-blind, placebo-controlled trial of the effects of the “party pills” BZP/TFMPP alone and in combination with alcohol. J Psychopharmacol. 2010;24(9):1299–308. https://doi.org/10.1177/0269881109102608.CrossRefPubMed

21.

Wood DM, Dargan PI. Use and acute toxicity associated with the novel psychoactive substances diphenylprolinol (D2PM) and desoxypipradrol (2-DPMP). Clin Toxicol (Phila). 2012;50(8):727–32. https://doi.org/10.3109/15563650.2012.716158.CrossRef

22.

Murray DB, et al. ‘Ivory wave’ toxicity in recreational drug users; integration of clinical and poisons information services to manage legal high poisoning. Clin Toxicol (Phila). 2012;50(2):108–13. https://doi.org/10.3109/15563650.2011.647992.CrossRef

23.

Rosenberg J, et al. Hyperthermia associated with drug intoxication. Crit Care Med. 1986;14(11):964–9. https://doi.org/10.1097/00003246-198611000-00011.CrossRefPubMed

24.

• Rusyniak DE, Sprague JE. Toxin-induced hyperthermic syndromes. Med Clin North Am. 2005;89(6):1277–96. Review of toxin-induced hyperthermia syndromes related to appropriate diagnosis and treatment of these conditions. https://doi.org/10.1016/j.mcna.2005.06.002.CrossRefPubMed

25.

Levy P, et al. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med. 2007;50(2):144–52. https://doi.org/10.1016/j.annemergmed.2007.02.022.CrossRefPubMed

26.

Eisenach JC, De Kock M, Klimscha W. Alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984-1995). Anesthesiology. 1996;85(3):655–74. https://doi.org/10.1097/00000542-199609000-00026.CrossRefPubMed

27.

Simic J, et al. Acute myocardial infarction as a complication of clonidine withdrawal. J Emerg Med. 2003;25(4):399–402. https://doi.org/10.1016/j.jemermed.2003.04.002.CrossRefPubMed

28.

Reid JL, Campbell BC, Hamilton CA. Withdrawal reactions following cessation of central alpha-adrenergic receptor agonists. Hypertension. 1984;6(5 Pt 2):II71–5.PubMed

29.

Sarlis NJ, et al. Hyperadrenergic state following acute withdrawal from clonidine used at supratherapeutic doses. Clin Auton Res. 1996;6(2):115–7. https://doi.org/10.1007/BF02291233.CrossRefPubMed

30.

Leckman JF, et al. Rebound phenomena in Tourette’s syndrome after abrupt withdrawal of clonidine. Behavioral, cardiovascular, and neurochemical effects. Arch Gen Psychiatry. 1986;43(12):1168–76. https://doi.org/10.1001/archpsyc.1986.01800120054011.CrossRefPubMed

31.

Berge KH, Lanier WL. Myocardial infarction accompanying acute clonidine withdrawal in a patient without a history of ischemic coronary artery disease. Anesth Analg. 1991;72(2):259–61. https://doi.org/10.1213/00000539-199102000-00023.CrossRefPubMed

32.

Jain P, Misra A. Non-sustained ventricular tachycardia following clonidine withdrawal. Postgrad Med J. 1991;67(786):403–4. https://doi.org/10.1136/pgmj.67.786.403.CrossRefPubMedPubMedCentral

33.

Abrich V, Martin P, Hennick M. Vertebral artery dissection and lateral medullary stroke associated with neck trauma and clonidine withdrawal. N Am J Med Sci. 2013;5(7):443–4. https://doi.org/10.4103/1947-2714.115767.CrossRefPubMedPubMedCentral

34.

Shaw M, Matsa R. Clonidine withdrawal induced sympathetic surge. BMJ Case Rep. 2015;2015

35.

Fitzgibbon D, et al. Rebound hypertension and withdrawal associated with discontinuation of an infusion of epidural clonidine. Anesthesiology. 1996;84(3):729–31. https://doi.org/10.1097/00000542-199603000-00031.CrossRefPubMed

36.

Lee HM, Ruggoo V, Graudins A. Intrathecal clonidine pump failure causing acute withdrawal syndrome with ‘Stress-Induced’ cardiomyopathy. J Med Toxicol. 2016;12(1):134–8. https://doi.org/10.1007/s13181-015-0505-9.CrossRefPubMed

37.

Gupta P, et al. Safety and efficacy of prolonged dexmedetomidine use in critically ill children with heart disease. Pediatr Crit Care Med. 2012;13(6):660–6. https://doi.org/10.1097/PCC.0b013e318253c7f1.CrossRefPubMed

38.

• Shehabi Y, et al. Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects. Intensive Care Med. 2004;30(12):2188–96. Helpful review of alpha ₂ agonist withdrawal in the form of an editorial, discussing the possibility of tolerance and withdrawal from an ICU physician perspective. https://doi.org/10.1007/s00134-004-2417-z.CrossRefPubMed

39.

Kukoyi A, et al. Two cases of acute dexmedetomidine withdrawal syndrome following prolonged infusion in the intensive care unit: report of cases and review of the literature. Hum Exp Toxicol. 2013;32(1):107–10. https://doi.org/10.1177/0960327112454896.CrossRefPubMed

40.

Weber MD, Thammasitboon S, Rosen DA. Acute discontinuation syndrome from dexmedetomidine after protracted use in a pediatric patient. Paediatr Anaesth. 2008;18(1):87–8. https://doi.org/10.1111/j.1460-9592.2007.02377.x.CrossRefPubMed

41.

Houston MC. Treatment of hypertensive emergencies and urgencies with oral clonidine loading and titration. A review. Arch Intern Med. 1986;146(3):586–9. https://doi.org/10.1001/archinte.1986.00360150236029.CrossRefPubMed

42.

Gagnon DJ, et al. Transition from dexmedetomidine to enteral clonidine for ICU sedation: an observational pilot study. Pharmacotherapy. 2015;35(3):251–9. https://doi.org/10.1002/phar.1559.CrossRefPubMed

43.

Lardieri AB, et al. Effects of clonidine on withdrawal from long-term dexmedetomidine in the pediatric patient. J Pediatr Pharmacol Ther. 2015;20(1):45–53. https://doi.org/10.5863/1551-6776-20.1.45.PubMedPubMedCentral

44.

Tobias JD. Dexmedetomidine: are tolerance and withdrawal going to be an issue with long-term infusions? Pediatr Crit Care Med. 2010;11(1):158–60. https://doi.org/10.1097/PCC.0b013e3181ae49af.CrossRefPubMed

45.

Bowcock E, Morris I, Lane A. Dexmedetomidine for acute clonidine withdrawal following intrathecal pump removal: a drug beginning to find its expanding niche. J Intensive Care Soc. 2016;17(3):271–2. https://doi.org/10.1177/1751143716638374.CrossRefPubMedPubMedCentral

46.

Awuor SO, et al. Intrathecal baclofen withdrawal: a rare cause of reversible cardiomyopathy. Acute Card Care. 2016;18(1):13–7. https://doi.org/10.3109/17482941.2016.1174273.CrossRefPubMed

47.

Cardoso AL, Quintaneiro C, Seabra H, Teixeira C. Cardiac arrest due to baclofen withdrawal syndrome. BMJ Case Rep. 2014. https://doi.org/10.1136/bcr-2014-204322.

48.

D’Aleo G, et al. Hallucinations after abrupt withdrawal of oral and intrathecal baclofen. Funct Neurol. 2007;22(2):81–8.PubMed

49.

Stetkarova I, et al. Intrathecal baclofen in spinal spasticity: frequency and severity of withdrawal syndrome. Pain Physician. 2015;18(4):E633–41.PubMed

50.

•• Watve SV, et al. Management of acute overdose or withdrawal state in intrathecal baclofen therapy. Spinal Cord. 2012;50(2):107–11. Recent review of studies relevant to the management of patients with intrathecal baclofen overdose and withdrawal. https://doi.org/10.1038/sc.2011.112.CrossRefPubMed

51.

Specchio N, et al. Prolonged episode of dystonia and dyskinesia resembling status epilepticus following acute intrathecal baclofen withdrawal. Epilepsy Behav. 2011;21(3):321–3. https://doi.org/10.1016/j.yebeh.2011.04.052.CrossRefPubMed

52.

Kao LW, et al. Intrathecal baclofen withdrawal mimicking sepsis. J Emerg Med. 2003;24(4):423–7. https://doi.org/10.1016/S0736-4679(03)00039-8.CrossRefPubMed

53.

Morr S, et al. Dexmedetomidine for acute baclofen withdrawal. Neurocrit Care. 2015;22(2):288–92. https://doi.org/10.1007/s12028-014-0083-8.CrossRefPubMed

54.

Greenberg MI, Hendrickson RG. Baclofen withdrawal following removal of an intrathecal baclofen pump despite oral baclofen replacement. J Toxicol Clin Toxicol. 2003;41(1):83–5. https://doi.org/10.1081/CLT-120018277.CrossRefPubMed

55.

• Finkel JB, Marhefka GD. Rethinking cocaine-associated chest pain and acute coronary syndromes. Mayo Clin Proc. 2011;86(12):1198–207. Review of cocaine-associated chest pain and beta-blocker use from a unique author’s perspective. https://doi.org/10.4065/mcp.2011.0338.CrossRefPubMedPubMedCentral

56.

• Freeman K, Feldman JA. Cocaine, myocardial infarction, and beta-blockers: time to rethink the equation? Ann Emerg Med. 2008;51(2):130–4. Review of cocaine-associated chest pain and beta-blocker use from a unique author’s perspective. https://doi.org/10.1016/j.annemergmed.2007.08.020.CrossRefPubMed

57.

• Leikin JB. Cocaine and beta-adrenergic blockers: a remarriage after a decade-long divorce? Crit Care Med. 1999;27(4):688–9. Review of cocaine-associated chest pain and beta-blocker use from a unique author’s perspective. https://doi.org/10.1097/00003246-199904000-00012.CrossRefPubMed

58.

• Mariani PJ. Beta-blockers following cocaine use: a reappraisal. Ann Emerg Med. 2008;52(1):89; author reply 89–90. Review of cocaine-associated chest pain and beta-blocker use from a unique author’s perspective. https://doi.org/10.1016/j.annemergmed.2007.11.048.

59.

• Page RL II, Utz KJ, Wolfel EE. Should beta-blockers be used in the treatment of cocaine-associated acute coronary syndrome? Ann Pharmacother. 2007;41(12):2008–13. Review of cocaine-associated chest pain and beta-blocker use from a unique author’s perspective. https://doi.org/10.1345/aph.1H643.CrossRefPubMed

60.

• Richards JR, et al. Beta-blockers, cocaine, and the unopposed alpha-stimulation phenomenon. J Cardiovasc Pharmacol Ther. 2017;22(3):239–49. Review of cocaine-associated chest pain and beta-blocker use from a unique author’s perspective. https://doi.org/10.1177/1074248416681644.CrossRefPubMed

61.

• Schurr JW, Gitman B, Belchikov Y. Controversial therapeutics: the beta-adrenergic antagonist and cocaine-associated cardiovascular complications dilemma. Pharmacotherapy. 2014;34(12):1269–81. Review of cocaine-associated chest pain and beta-blocker use from a unique author’s perspective. https://doi.org/10.1002/phar.1486.CrossRefPubMed

62.

•• Richards JR, et al. Treatment of cocaine cardiovascular toxicity: a systematic review. Clin Toxicol (Phila). 2016;54(5):345–64. Most extensive and recent review on available evidence regarding the treatment of cocaine-related cardiovascular toxicity to date. https://doi.org/10.3109/15563650.2016.1142090.CrossRef

63.

Hysek CM, Vollenweider FX, Liechti ME. Effects of a beta-blocker on the cardiovascular response to MDMA (Ecstasy). Emerg Med J. 2010;27(8):586–9. https://doi.org/10.1136/emj.2009.079905.CrossRefPubMed

64.

Burkhart KK. Intravenous propranolol reverses hypertension after sympathomimetic overdose: two case reports. J Toxicol Clin Toxicol. 1992;30(1):109–14. https://doi.org/10.3109/15563659208994450.CrossRefPubMed

65.

Rappolt RT Sr, et al. Treatment plan for acute and chronic adrenergic poisoning crisis utilizing sympatholytic effects of the B1-B2 receptor site blocker propranolol (Inderal) in concert with diazepam and urine acidification. Clin Toxicol. 1979;14(1):55–69. https://doi.org/10.3109/15563657909030114.CrossRefPubMed

66.

Akay S, Ozdemir M. Acute coronary syndrome presenting after pseudoephedrine use and regression with beta-blocker therapy. Can J Cardiol. 2008;24(11):e86–8. https://doi.org/10.1016/S0828-282X(08)70200-9.CrossRefPubMedPubMedCentral

67.

• Dattilo PB, Hailpern SM, Fearon K, Sohal D, Nordin C. Beta-blockers are associated with reduced risk of myocardial infarction after cocaine use. Ann Emerg Med. 2008;51(2):117–25. Retrospective cohort study demonstrating an association of reduced risk for MI in patients with positive drug screens for cocaine who received beta blockade during admission. https://doi.org/10.1016/j.annemergmed.2007.04.015.CrossRefPubMed

68.

Hoskins MH, et al. Effects of labetalol on hemodynamic parameters and soluble biomarkers of inflammation in acute coronary syndrome in patients with active cocaine use. J Cardiovasc Pharmacol Ther. 2010;15(1):47–52. https://doi.org/10.1177/1074248409358409.CrossRefPubMed

69.

• Ibrahim M, Maselli DJ, Hasan R, Hamilton A. Safety of beta-blockers in the acute management of cocaine-associated chest pain. Am J Emerg Med. 2013;31(3):613–6. Retrospective chart review of patients with cocaine-associated chest pain showing no increase in troponin in patients who received beta blockers during admission compared to those who did not. https://doi.org/10.1016/j.ajem.2012.09.027.CrossRefPubMed

70.

• Rangel C, et al. Beta-blockers for chest pain associated with recent cocaine use. Arch Intern Med. 2010;(10):170, 874–9. Retrospective review of patients with positive urine drug screen for coccaine comparing those who received a beta-blocker with those who did not, showing no association with adverse event.

71.

•• Honderick T, Williams D, Seaberg D, Wears R. A prospective, randomized, controlled trial of benzodiazepines and nitroglycerine or nitroglycerine alone in the treatment of cocaine-associated acute coronary syndromes. Am J Emerg Med. 2003;21(1):39–42. Basis of the evidence for benzodiazepine use in cocaine-associated chest pain. Randomized controlled trial showing improvement in pain in patients who received lorazepam + nitroglycerine vs nitroglycerin alone. https://doi.org/10.1053/ajem.2003.50010.CrossRefPubMed

72.

• Baumann BM, Perrone J, Hornig SE, Shofer FS, Hollander JE. Randomized, double-blind, placebo-controlled trial of diazepam, nitroglycerin, or both for treatment of patients with potential cocaine-associated acute coronary syndromes. Acad Emerg Med. 2000;7(8):878–85. Randomized controlled trial showing no difference in diazepam + nitroglycerin versus nitroglycerin alone in the resolution chest pain or changes in stroke index. https://doi.org/10.1111/j.1553-2712.2000.tb02065.x.CrossRefPubMed

73.

Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334(8):494–500. https://doi.org/10.1056/NEJM199602223340803.CrossRefPubMed

74.

Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc. 2010;85(5):427–32. https://doi.org/10.4065/mcp.2009.0590.CrossRefPubMedPubMedCentral

75.

•• Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 2015;14(9):914–25. Most recent and comprehensive review regarding etiology, diagnosis, and treatment of PRES to date. https://doi.org/10.1016/S1474-4422(15)00111-8.CrossRefPubMed

76.

Granata G, et al. Posterior reversible encephalopathy syndrome—insight into pathogenesis, clinical variants and treatment approaches. Autoimmun Rev. 2015;14(9):830–6. https://doi.org/10.1016/j.autrev.2015.05.006.CrossRefPubMed

77.

Zekic T, et al. The multifactorial origin of posterior reversible encephalopathy syndrome in cyclophosphamide-treated lupus patients. Rheumatol Int. 2017;37(12):2105–14. https://doi.org/10.1007/s00296-017-3843-x.CrossRefPubMed

78.

Gharabawy R, et al. Epinephrine-induced posterior reversible encephalopathy syndrome: a case report. J Clin Anesth. 2011;23(6):505–7. https://doi.org/10.1016/j.jclinane.2010.12.017.CrossRefPubMed

79.

Jayaweera JL, et al. Cyclophosphamide-induced posterior reversible encephalopathy syndrome (PRES): a case report. J Med Case Rep. 2014;8(1):442. https://doi.org/10.1186/1752-1947-8-442.CrossRefPubMedPubMedCentral

80.

Omer TA, Doherty C. Posterior reversible encephalopathy syndrome (PRES) complicating the ‘legal high’ mephedrone. BMJ Case Rep. 2011;2011

81.

• Song T, Rao Z, Tan Q, Qiu Y, Liu J, Huang Z, et al. Calcineurin inhibitors associated posterior reversible encephalopathy syndrome in solid organ transplantation: report of 2 cases and literature review. Medicine (Baltimore). 2016;95(14):e3173. Good recent review and report of current understanding regarding the connection between PRES and 2 of its most commonly associated agents. https://doi.org/10.1097/MD.0000000000003173.CrossRef

82.

Wang W, Zhao LR, Lin XQ, Feng F. Reversible posterior leukoencephalopathy syndrome induced by bevacizumab plus chemotherapy in colorectal cancer. World J Gastroenterol. 2014;20(21):6691–7. https://doi.org/10.3748/wjg.v20.i21.6691.CrossRefPubMedPubMedCentral

Titel: Sympathomimetic Toxidromes and Other Pharmacological Causes of Acute Hypertension
verfasst von: Andrew King
Mirjana Dimovska
Luke Bisoski
Publikationsdatum: 01.01.2018
Verlag: Springer US
Erschienen in: Current Hypertension Reports / Ausgabe 1/2018
Print ISSN: 1522-6417
Elektronische ISSN: 1534-3111
DOI: https://doi.org/10.1007/s11906-018-0807-9

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