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Vascular Endothelial Function and Hypertension: Insights and Directions

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Abstract

Hypertension contributes significantly to worldwide cardiovascular morbidity and mortality. Hypertension appears to have a complex association with endothelial dysfunction, a phenotypical alteration of the vascular endothelium that precedes the development of adverse cardiovascular events and portends future cardiovascular risk. This review concentrates on recent findings with respect to the mechanisms of hypertension-associated endothelial dysfunction, the interrelationship between these two entities, and the relationship of the efficacy of antihypertensive therapies to improvements in vascular homeostasis beyond blood pressure reduction. Current evidence suggests that hypertension and endothelial dysfunction are integrally related with respect to pathophysiologic mechanisms. Future studies will need to identify the key connections between hypertension and endothelial dysfunction to allow novel interventions to be designed and promulgated.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Egan BM, Zhao Y, Axon RN: US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA 2010, 303:2043–2050.

    Article  CAS  PubMed  Google Scholar 

  2. Whitworth JA: 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003, 21:1983–1992.

    Article  PubMed  Google Scholar 

  3. Widlansky ME, Gokce N, Keaney JF Jr, Vita JA: The clinical implications of endothelial dysfunction. J Am Coll Cardiol 2003, 42:1149–1160.

    Article  CAS  PubMed  Google Scholar 

  4. Gokce N, Keaney JF Jr, Vita JA (1998) Endotheliopathies: Clinical manifestations of endothelial dysfunction. In: Loscalzo J, Shafer AI (eds) Thrombosis and Hemorrhage. Baltimore: Williams & Wilkins, pp 901–924.

    Google Scholar 

  5. Vita JA, Keaney JF Jr: Endothelial function: a barometer for cardiovascular risk? Circulation 2002, 106:640–642.

    Article  PubMed  Google Scholar 

  6. Modena MG, Bonetti L, Coppi F, et al.: Prognostic role of reversible endothelial dysfunction in hypertensive postmenopausal women. J Am Coll Cardiol 2002, 40:505–510.

    Article  PubMed  Google Scholar 

  7. •• Kitta Y, Obata JE, Nakamura T, et al.: Persistent impairment of endothelial vasomotor function has a negative impact on outcome in patients with coronary artery disease. J Am Coll Cardiol 2009, 53:323–330. The authors measured endothelial function by brachial artery reactivity immediately following the diagnosis of cardiovascular disease in 251 patients and remeasured endothelial function 6 months after initiation of intensive therapy. Those with persistently impaired brachial artery reactivity had a significantly higher 3-year event rate (26%) than those with improved reactivity on therapy (10%). Persistent impairment of endothelial dysfunction was an independent predictor of cardiovascular risk.

  8. McMackin CJ, Vita JA: Update on nitric oxide—dependent vasodilation in human subjects. Methods Enzymol 2005, 396:541–553.

    Article  CAS  PubMed  Google Scholar 

  9. Hamburg NM, Benjamin EJ: Assessment of endothelial function using digital pulse amplitude tonometry. Trends Cardiovasc Med 2009, 19:6–11.

    Article  CAS  PubMed  Google Scholar 

  10. Furchgott RF, Zawadzki JV: The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature 1980, 288:373–376.

    Article  CAS  PubMed  Google Scholar 

  11. Ignarro LJ, Edwards JC, Gruetter DY, et al.: Possible involvement of S-nitrosothiols in the activation of guanylate cyclase by nitroso compounds. FEBS Lett 1980, 110:275–278.

    Article  CAS  PubMed  Google Scholar 

  12. Ludmer PL, Selwyn AP, Shook TL, et al.: Paradoxical vasoconstriction induced by acetylcholine in atherosclerotic coronary arteries. N Engl J Med 1986, 315:1046–1051.

    Article  CAS  PubMed  Google Scholar 

  13. Cox DA, Vita JA, Treasure CB, et al.: Atherosclerosis impairs flow-mediated dilation of coronary arteries in humans. Circulation 1989, 80:458–465.

    CAS  PubMed  Google Scholar 

  14. Corretti MC, Anderson TJ, Benjamin EJ, et al.: Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol 2002, 39:257–265.

    Article  PubMed  Google Scholar 

  15. Benjamin EJ, Larson MG, Keyes MJ, et al.: Clinical correlates and heritability of flow-mediated dilation in the community: the Framingham Heart Study. Circulation 2004, 109:613–619.

    Article  PubMed  Google Scholar 

  16. Harrison DG, Gongora MC: Oxidative stress and hypertension. Med Clin North Am 2009, 93:621–635.

    Article  CAS  PubMed  Google Scholar 

  17. Kizhakekuttu TJ, Widlansky ME: Natural antioxidants and hypertension: promise and challenges. Cardiovasc Ther 2010, 28:e20–e32.

    Article  CAS  PubMed  Google Scholar 

  18. Widder JD, Fraccarollo D, Galuppo P, et al.: Attenuation of angiotensin II-induced vascular dysfunction and hypertension by overexpression of thioredoxin 2. Hypertension 2009, 54:338–344.

    Article  CAS  PubMed  Google Scholar 

  19. Vecchione C, Carnevale D, Di PA, et al.: Pressure-induced vascular oxidative stress is mediated through activation of integrin-linked kinase 1/betaPIX/Rac-1 pathway. Hypertension 2009, 54:1028–1034.

    Article  CAS  PubMed  Google Scholar 

  20. Doughan AK, Harrison DG, Dikalov SI: Molecular mechanisms of angiotensin II-mediated mitochondrial dysfunction: linking mitochondrial oxidative damage and vascular endothelial dysfunction. Circ Res 2008, 102:488–496.

    Article  CAS  PubMed  Google Scholar 

  21. Shoelson SE, Lee J, Goldfine AB: Inflammation and insulin resistance. J Clin Invest 2006, 116:1793–1801.

    Article  CAS  PubMed  Google Scholar 

  22. Apovian CM, Bigornia S, Mott M, et al.: Adipose macrophage infiltration is associated with insulin resistance and vascular endothelial dysfunction in obese subjects. Arterioscler Thromb Vasc Biol 2008, 28:1654–1659.

    Article  CAS  PubMed  Google Scholar 

  23. Zeng ZH, Zhang ZH, Luo BH, et al.: The functional changes of the perivascular adipose tissue in spontaneously hypertensive rats and the effects of atorvastatin therapy. Clin Exp Hypertens 2009, 31:355–363.

    Article  CAS  PubMed  Google Scholar 

  24. Marchesi C, Ebrahimian T, Angulo O, et al.: Endothelial nitric oxide synthase uncoupling and perivascular adipose oxidative stress and inflammation contribute to vascular dysfunction in a rodent model of metabolic syndrome. Hypertension 2009, 54:1384–1392.

    Article  CAS  PubMed  Google Scholar 

  25. Magen E, Feldman A, Cohen Z, et al.: Potential link between C3a, C3b and endothelial progenitor cells in resistant hypertension. Am J Med Sci 2010, 339:415–419.

    Article  PubMed  Google Scholar 

  26. Didion SP, Kinzenbaw DA, Schrader LI, et al.: Endogenous interleukin-10 inhibits angiotensin II-induced vascular dysfunction. Hypertension 2009, 54:619–624.

    Article  CAS  PubMed  Google Scholar 

  27. Hill JM, Zalos G, Halcox JP, et al.: Circulating endothelial progenitor cells, vascular function, and cardiovascular risk. N Engl J Med 2003, 348:593–600.

    Article  PubMed  Google Scholar 

  28. Wassmann S, Werner N, Czech T, Nickenig G: Improvement of endothelial function by systemic transfusion of vascular progenitor cells. Circ Res 2006, 99:e74–e83.

    Article  CAS  PubMed  Google Scholar 

  29. Giannotti G, Doerries C, Mocharla PS, et al.: Impaired endothelial repair capacity of early endothelial progenitor cells in prehypertension: relation to endothelial dysfunction. Hypertension 2010, 55:1389–1397.

    Article  CAS  PubMed  Google Scholar 

  30. Hage FG, Oparil S, Xing D, et al.: C-reactive protein-mediated vascular injury requires complement. Arterioscler Thromb Vasc Biol 2010, 30:1189–1195.

    Article  CAS  PubMed  Google Scholar 

  31. Vita JA, Treasure CB, Nabel EG, et al.: Coronary vasomotor response to acetylcholine relates to risk factors for coronary artery disease. Circulation 1990, 81:491–497.

    CAS  PubMed  Google Scholar 

  32. Treasure CB, Manoukian SV, Klein JL, et al.: Epicardial coronary artery responses to acetylcholine are impaired in hypertensive patients. Circ Res 1992, 71:776–781.

    CAS  PubMed  Google Scholar 

  33. Panza JA, Quyyumi AA, Brush JE, Epstein SE: Abnormal endothelium-dependent vascular relaxation in patients with essential hypertension. N Engl J Med 1990, 323:22–27.

    Article  CAS  PubMed  Google Scholar 

  34. Panza JA, Casino PR, Kilcoyne CM, Quyyumi AA: Role of endothelium-derived nitric oxide in the abnormal endothelium-dependent vascular relaxation of patients with essential hypertension. Circulation 1993, 87:1468–1474.

    CAS  PubMed  Google Scholar 

  35. Panza JA, Garcia CE, Kilcoyne CM, et al.: Impaired endothelium-dependent vasodilation in patients with essential hypertension: evidence that nitric oxide abnormality is not localized to a single signal transduction pathway. Circulation 1995, 91:1732–1738.

    CAS  PubMed  Google Scholar 

  36. Sander M, Chavoshan B, Victor RG: A large blood pressure-raising effect of nitric oxide synthase inhibition in humans. Hypertension 1999, 33:937–942.

    CAS  PubMed  Google Scholar 

  37. Rossi R, Chiurlia E, Nuzzo A, et al.: Flow-mediated vasodilation and the risk of developing hypertension in healthy postmenopausal women. J Am Coll Cardiol 2004, 44:1636–1640.

    Article  PubMed  Google Scholar 

  38. Jurva JW, Phillips SA, Syed AQ, et al.: The effect of exertional hypertension evoked by weight lifting on vascular endothelial function. J Am Coll Cardiol 2006, 48(3):588–589.

    Article  PubMed  Google Scholar 

  39. Juonala M, Viikari JS, Ronnemaa T, et al.: Elevated blood pressure in adolescent boys predicts endothelial dysfunction: the Cardiovascular Risk in Young Finns Study. Hypertension 2006, 48:424–430.

    Article  CAS  PubMed  Google Scholar 

  40. •• Shimbo D, Muntner P, Mann D, et al.: Endothelial dysfunction and the risk of hypertension: the Multi-Ethnic Study of Atherosclerosis. Hypertension 2010, 55:1210–1216. The investigators measured endothelial function by brachial artery reactivity in 3500 ethnically diverse, nonhypertensive individuals in the Multi-ethnic Study of Atherosclerosis (MESA). Brachial reactivity was not found to be an independent predictor of the future development of hypertension after adjustment for other risk factors. This is the largest and most diverse study to address the question of directionality of the relationship of hypertension and endothelial dysfunction, and the data support the concept of endothelial dysfunction as an effect of hypertension rather than a cause of it.

  41. Quyyumi AA, Patel RS: Endothelial dysfunction and hypertension: cause or effect? Hypertension 2010, 55:1092–1094.

    Article  CAS  PubMed  Google Scholar 

  42. •• Bibbins-Domingo K, Chertow GM, Coxson PG, et al.: Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med 2010, 362:590–599. The authors employed the Coronary Heart Disease Policy Model to determine the potential achievable reductions in cardiovascular risk from reducing dietary salt by up to 3 grams per day. The authors report that such a reduction would lead to significant reductions in stroke, myocardial infarction, and cardiovascular death.

  43. He FJ, MacGregor GA: Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev 2004, (3):CD004937.

  44. Kopkan L, Majid DS: Superoxide contributes to development of salt sensitivity and hypertension induced by nitric oxide deficiency. Hypertension 2005, 46:1026–1031.

    Article  CAS  PubMed  Google Scholar 

  45. Kopkan L, Majid DS: Enhanced superoxide activity modulates renal function in NO-deficient hypertensive rats. Hypertension 2006, 47:568–572.

    Article  CAS  PubMed  Google Scholar 

  46. Majid DS, Kopkan L: Nitric oxide and superoxide interactions in the kidney and their implication in the development of salt-sensitive hypertension. Clin Exp Pharmacol Physiol 2007, 34(9):946–952.

    Article  CAS  PubMed  Google Scholar 

  47. Jablonski KL, Gates PE, Pierce GL, Seals DR: Low dietary sodium intake is associated with enhanced vascular endothelial function in middle-aged and older adults with elevated systolic blood pressure. Ther Adv Cardiovasc Dis 2009, 3:347–356.

    Article  PubMed  Google Scholar 

  48. • McCall DO, McGartland CP, McKinley MC, et al.: Dietary intake of fruits and vegetables improves microvascular function in hypertensive subjects in a dose-dependent manner. Circulation 2009, 119:2153–2160. Individuals with hypertension were randomized to either 1, 3, or 6 servings per day of fresh fruits and vegetables after a 1-month run-in period with less than 1 serving per day. Endothelial function was assessed by forearm blood flow using venous plethysmography at the beginning and end of the 12-week intervention period. The authors found a 6.2% increase in forearm blood flow for each single-portion increase in fresh fruits and vegetables, demonstrating that increasing fruit and vegetable consumption can improve a surrogate marker of cardiovascular risk.

  49. Anter E, Thomas SR, Schulz E, et al.: Activation of eNOS by the p38 MAP kinase in response to black tea polyphenols. J Biol Chem 2004, 45:46637–46643.

    Article  Google Scholar 

  50. Widlansky ME, Duffy SJ, Hamburg NM, et al.: Effects of black tea consumption on plasma catechins, markers of oxidative stress and inflammation in patients with coronary artery disease. Free Radic Biol Med 2004, 38:499–506.

    Article  Google Scholar 

  51. Mancini GB, Henry GC, Macaya C, et al.: Angiotensin-converting enzyme inhibition with quinapril improves endothelial vasomotor dysfunction in patients with coronary artery disease. The TREND (Trial on Reversing ENdothelial Dysfunction) Study. Circulation 1996, 94:258–265.

    CAS  PubMed  Google Scholar 

  52. Prasad A, Husain S, Quyyumi AA: Abnormal flow-mediated epicardial vasomotion in human coronary arteries is improved by angiotensin-converting enzyme inhibition: a potential role of bradykinin. J Am Coll Cardiol 1999, 33:796–804.

    Article  CAS  PubMed  Google Scholar 

  53. Higashi Y, Sasaki S, Nakagawa K, et al.: A comparison of angiotensin-converting enzyme inhibitors, calcium antagonists, beta-blockers and diuretic agents on reactive hyperemia in patients with essential hypertension: a multicenter study. J Am Coll Cardiol 2000, 35:284–291.

    Article  CAS  PubMed  Google Scholar 

  54. Prasad A, Tupas-Habib T, Schenke WH, et al.: Acute and chronic angiotensin-1 receptor antagonism reverses endothelial dysfunction in atherosclerosis. Circulation 2000, 101:2349–2354.

    CAS  PubMed  Google Scholar 

  55. Tzemos N, Lim PO, MacDonald TM: Nebivolol reverses endothelial dysfunction in essential hypertension: a randomized, double-blind, crossover study. Circulation 2001, 104:511–514.

    Article  CAS  PubMed  Google Scholar 

  56. Ghiadoni L, Huang Y, Magagna A, et al.: Effect of acute blood pressure reduction on endothelial function in the brachial artery of patients with essential hypertension. J Hypertens 2001, 19(3 Pt 2):547–551.

    Article  CAS  PubMed  Google Scholar 

  57. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002, 288:2981–2997.

    Article  Google Scholar 

  58. Chobanian AV, Bakris GL, Black HR, et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003, 289:2560–2572.

    Article  CAS  PubMed  Google Scholar 

  59. Dahlof B, Devereux RB, Kjeldsen SE, et al.: Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint Reduction in Hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002, 359:995–1003.

    Article  CAS  PubMed  Google Scholar 

  60. Wing LM, Reid CM, Ryan P, et al.: A comparison of outcomes with angiotensin-converting enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med 2003, 348:583–592.

    Article  CAS  PubMed  Google Scholar 

  61. Jamerson K, Weber MA, Bakris GL, et al.: Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 2008, 359:2417–2428.

    Article  CAS  PubMed  Google Scholar 

  62. Ghiadoni L, Magagna A, Versari D, et al.: Different effect of antihypertensive drugs on conduit artery endothelial function. Hypertension 2003, 41:1281–1286.

    Article  CAS  PubMed  Google Scholar 

  63. Zhou MS, Jaimes EA, Raij L: Inhibition of oxidative stress and improvement of endothelial function by amlodipine in angiotensin II-infused rats. Am J Hypertens 2004, 17:167–171.

    Article  CAS  PubMed  Google Scholar 

  64. Imanishi T, Tsujioka H, Ikejima H, et al.: Renin inhibitor aliskiren improves impaired nitric oxide bioavailability and protects against atherosclerotic changes. Hypertension 2008, 52:563–572.

    Article  CAS  PubMed  Google Scholar 

  65. Yamamoto E, Kataoka K, Dong YF, et al.: Aliskiren enhances the protective effects of valsartan against cardiovascular and renal injury in endothelial nitric oxide synthase-deficient mice. Hypertension 2009, 54:633–638.

    Article  CAS  PubMed  Google Scholar 

  66. Cherney DZ, Lai V, Scholey JW, et al.: Effect of direct renin inhibition on renal hemodynamic function, arterial stiffness, and endothelial function in humans with uncomplicated type 1 diabetes: a pilot study. Diabetes Care 2010, 33:361–365.

    Article  CAS  PubMed  Google Scholar 

  67. Pitt B, Zannad F, Remme WJ, et al.: The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999, 341:709–717.

    Article  CAS  PubMed  Google Scholar 

  68. Schiffrin EL: Effects of aldosterone on the vasculature. Hypertension 2006, 47:312–318.

    Article  CAS  PubMed  Google Scholar 

  69. Sanz-Rosa D, Oubiña MP, Cediel E, et al.: Eplerenone reduces oxidative stress and enhances eNOS in SHR: vascular functional and structural consequences. Antioxid Redox Signal 2005, 7:1294–1301.

    Article  CAS  PubMed  Google Scholar 

  70. Leopold JA, Cap A, Scribner AW, et al.: Glucose-6-phosphate dehydrogenase deficiency promotes endothelial oxidant stress and decreases endothelial nitric oxide bioavailability. FASEB J 2001, 15:1771–1773.

    CAS  PubMed  Google Scholar 

  71. Leopold JA, Zhang YY, Scribner AW, et al.: Glucose-6-phosphate dehydrogenase overexpression decreases endothelial cell oxidant stress and increases bioavailable nitric oxide. Arterioscler Thromb Vasc Biol 2003, 23:411–417.

    Article  CAS  PubMed  Google Scholar 

  72. Leopold JA, Dam A, Maron BA, et al.: Aldosterone impairs vascular reactivity by decreasing glucose-6-phosphate dehydrogenase activity. Nat Med 2007, 13:189–197.

    Article  CAS  PubMed  Google Scholar 

  73. Virdis A, Neves MF, Amiri F, et al.: Spironolactone improves angiotensin-induced vascular changes and oxidative stress. Hypertension 2002, 40:504–510.

    Article  CAS  PubMed  Google Scholar 

  74. Vasan RS, Evans JC, Larson MG, et al.: Serum aldosterone and the incidence of hypertension in nonhypertensive persons. N Engl J Med 2004, 351:33–41.

    Article  CAS  PubMed  Google Scholar 

  75. Pratt JH: A not-so-modest proposal that a “modest” increase in aldosterone causes hypertension and more. Hypertension 2008, 51:39–40.

    Article  CAS  PubMed  Google Scholar 

  76. Farquharson CA, Struthers AD: Aldosterone induces acute endothelial dysfunction in vivo in humans: evidence for an aldosterone-induced vasculopathy. Clin Sci (Lond) 2002, 103:425–431.

    CAS  Google Scholar 

  77. Schmidt BM, Oehmer S, Delles C, et al.: Rapid nongenomic effects of aldosterone on human forearm vasculature. Hypertension 2003, 42:156–160.

    Article  CAS  PubMed  Google Scholar 

  78. Nishizaka MK, Zaman MA, Green SA, et al.: Impaired endothelium-dependent flow-mediated vasodilation in hypertensive subjects with hyperaldosteronism. Circulation 2004, 109:2857–2861.

    Article  CAS  PubMed  Google Scholar 

  79. Duffy SJ, Biegelsen ES, Eberhardt RT, et al.: Low-renin hypertension with relative aldosterone excess is associated with impaired NO-mediated vasodilation. Hypertension 2005, 46:707–713.

    Article  CAS  PubMed  Google Scholar 

  80. Kahn DF, Duffy SJ, Tomasian D, et al.: Effects of black race on forearm resistance vessel function. Hypertension 2002, 40:195–201.

    Article  CAS  PubMed  Google Scholar 

  81. Park S, Kim JB, Shim CY, et al.: The influence of serum aldosterone and the aldosterone-renin ratio on pulse wave velocity in hypertensive patients. J Hypertens 2007, 25:1279–1283.

    Article  CAS  PubMed  Google Scholar 

  82. Nguyen Dinh CA, Griol-Charhbili V, Loufrani L, et al.: The endothelial mineralocorticoid receptor regulates vasoconstrictor tone and blood pressure. FASEB J 2010, 24:2454–2463.

    Google Scholar 

  83. Sakurabayashi-Kitade S, Aoka Y, Nagashima H, et al.: Aldosterone blockade by spironolactone improves the hypertensive vascular hypertrophy and remodeling in angiotensin II overproducing transgenic mice. Atherosclerosis 2009, 206:54–60.

    Article  CAS  PubMed  Google Scholar 

  84. Tsuchiya K, Yoshimoto T, Hirata Y: Endothelial dysfunction is related to aldosterone excess and raised blood pressure. Endocr J 2009, 56:553–559.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

Dr. Dharmashankar is supported by a Ruth L. Kirschstein NIH T32 training grant (HL007792-15). Dr. Widlansky’s work is supported by K23HL089326, AHA Grant-in-Aid 10GRNT3880044, and a grant from the Greater Milwaukee Foundation.

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  1. Medical College of Wisconsin, 9200 West Wisconsin Avenue, FEC Suite E5100, Milwaukee, WI, 53226, USA

    Kodlipet Dharmashankar & Michael E. Widlansky

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Dharmashankar, K., Widlansky, M.E. Vascular Endothelial Function and Hypertension: Insights and Directions. Curr Hypertens Rep 12, 448–455 (2010). https://doi.org/10.1007/s11906-010-0150-2

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