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Risk Factors for Nonadherence to Antihypertensive Treatment

P. Gupta, P. Patel, B. Štrauch, FY. Lai, A. Akbarov, V. Marešová, CMJ. White, O. Petrák, GS. Gulsin, V. Patel, J. Rosa, R. Cole, T. Zelinka, R. Holaj, A. Kinnell, PR. Smith, JR. Thompson, I. Squire, J. Widimský, NJ. Samani, B. Williams, M. Tomaszewski,

. 2017 ; 69 (6) : 1113-1120. [pub] 20170501

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články, multicentrická studie

Perzistentní odkaz   https://www.medvik.cz/link/bmc17030845

Nonadherence to antihypertensive treatment is a critical contributor to suboptimal blood pressure control. There are limited and heterogeneous data on the risk factors for nonadherence because few studies used objective-direct diagnostic methods. We used high-performance liquid chromatography-tandem mass spectrometry of urine and serum to detect nonadherence and explored its association with the main demographic- and therapy-related factors in 1348 patients with hypertension from 2 European countries. The rates of nonadherence to antihypertensive treatment were 41.6% and 31.5% in the UK and Czech populations, respectively. Nonadherence was inversely related to age and male sex. Each increase in the number of antihypertensive medications led to 85% and 77% increase in nonadherence (P<0.001) in the UK and Czech populations, respectively. The odds of nonadherence to diuretics were the highest among 5 classes of antihypertensive medications (P≤0.005 in both populations). The predictive model for nonadherence, including age, sex, diuretics, and the number of prescribed antihypertensives, showed area under the curves of 0.758 and 0.710 in the UK and Czech populations, respectively. The area under the curves for the UK model tested on the Czech data and for the Czech model tested on UK data were calculated at 0.708 and 0.756, respectively. We demonstrate that the number and class of prescribed antihypertensives are modifiable risk factors for biochemically confirmed nonadherence to blood pressure-lowering therapy. Further development of discriminatory models incorporating these parameters might prove clinically useful in assessment of nonadherence in countries where biochemical analysis is unavailable.

Citace poskytuje Crossref.org

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$a 10.1161/HYPERTENSIONAHA.116.08729 $2 doi
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$a Gupta, Pankaj $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
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$a Risk Factors for Nonadherence to Antihypertensive Treatment / $c P. Gupta, P. Patel, B. Štrauch, FY. Lai, A. Akbarov, V. Marešová, CMJ. White, O. Petrák, GS. Gulsin, V. Patel, J. Rosa, R. Cole, T. Zelinka, R. Holaj, A. Kinnell, PR. Smith, JR. Thompson, I. Squire, J. Widimský, NJ. Samani, B. Williams, M. Tomaszewski,
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$a Nonadherence to antihypertensive treatment is a critical contributor to suboptimal blood pressure control. There are limited and heterogeneous data on the risk factors for nonadherence because few studies used objective-direct diagnostic methods. We used high-performance liquid chromatography-tandem mass spectrometry of urine and serum to detect nonadherence and explored its association with the main demographic- and therapy-related factors in 1348 patients with hypertension from 2 European countries. The rates of nonadherence to antihypertensive treatment were 41.6% and 31.5% in the UK and Czech populations, respectively. Nonadherence was inversely related to age and male sex. Each increase in the number of antihypertensive medications led to 85% and 77% increase in nonadherence (P<0.001) in the UK and Czech populations, respectively. The odds of nonadherence to diuretics were the highest among 5 classes of antihypertensive medications (P≤0.005 in both populations). The predictive model for nonadherence, including age, sex, diuretics, and the number of prescribed antihypertensives, showed area under the curves of 0.758 and 0.710 in the UK and Czech populations, respectively. The area under the curves for the UK model tested on the Czech data and for the Czech model tested on UK data were calculated at 0.708 and 0.756, respectively. We demonstrate that the number and class of prescribed antihypertensives are modifiable risk factors for biochemically confirmed nonadherence to blood pressure-lowering therapy. Further development of discriminatory models incorporating these parameters might prove clinically useful in assessment of nonadherence in countries where biochemical analysis is unavailable.
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$a Patel, Prashanth $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
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$a Štrauch, Branislav $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Lai, Florence Y $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Akbarov, Artur $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.). $7 gn_A_00002847
700    1_
$a Marešová, Věra $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a White, Christobelle M J $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Petrák, Ondřej $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Gulsin, Gaurav S $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Patel, Veena $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Rosa, Ján $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Cole, Richard $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Zelinka, Tomáš $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Holaj, Robert $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Kinnell, Angela $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Smith, Paul R $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Thompson, John R $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Squire, Iain $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Widimský, Jiří $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Samani, Nilesh J $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Williams, Bryan $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.).
700    1_
$a Tomaszewski, Maciej $u From the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, United Kingdom (P.G., P.P., R.C., A.K., P.R.S.); National Institute of Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (P.G., P.P., F.Y.L., G.S.G., I.S., N.J.S.); Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre (P.G., P.P., F.Y.L., C.M.J.W., G.S.G., I.S., N.J.S.) and Department of Health Sciences (J.R.T.), University of Leicester, United Kingdom; Third Department of Medicine, Department of Endocrinology and Metabolism, Hypertension Centre, General University Hospital (B.S., O.P., J.R., T.Z., R.H., J.W.), Institute of Forensic Medicine and Toxicology, General University Hospital (V.M.), and Cardiocentre, University Hospital Královské Vinohrady (J.R.), Charles University, Prague, Czech Republic; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (A.A., M.T.); University Hospitals of Leicester NHS Trust, United Kingdom (G.S.G.); Derby Teaching Hospitals NHS Foundation Trust, United Kingdom (V.P.); Institute of Cardiovascular Science, University College London, United Kingdom (B.W.); National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (B.W.); and Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.). maciej.tomaszewski@manchester.ac.uk.
773    0_
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