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J C Seidell

Publications and source records attributed to J C Seidell.

At least 91 records · Page 5Linked to original sources
PubMed1998

Dietary fat and obesity: an epidemiologic perspective.

The observation that dietary fat has an effect on weight gain and the development of obesity that is larger than would be expected on the basis of fat's energy value is mainly experimental. Several methodologic problems limit the interpretation of epidemiologic studies of the association between dietary fat intake and obesity. Among the issues relevant in this context are underreporting of energy and fat intakes, dieting behavior, inadequate control for variables such as energy expenditure, and limited between-subject variation in fat intake in developed countries. Different types of epidemiologic studies suffer from different types and magnitudes of bias and many conflicting results can be obtained. Ecologic and cross-sectional studies especially suffer from these biases. The more appropriate type of study (ie, prospective studies of fat intake and subsequent weight gain) was carried out in several countries but conflicting results were obtained. Overall, the observed associations seem to depend on the stage of cultural transition of the population studied (eg, modernization compared with postmodernization). Current epidemiologic methods are inadequate for performing valid studies of the relation between percentage of energy from dietary fat and obesity. Specifically designed prospective studies of unbiased estimates of energy balance are necessary. Appropriate control for confounders and emphasis on the possibility that genetic predisposition plays a role will also be necessary. At this stage there is no conclusive evidence from epidemiologic studies that under isoenergetic conditions dietary fat intake promotes the development of obesity more so than other macronutrients.

Body Mass Index↗
PubMed1998

Underreporting of energy, protein and potassium intake in relation to body mass index.

BACKGROUND: Differential underreporting of dietary intake by subgroups of body mass index (BMI) will confound associations between dietary intake and BMI-related diseases. We estimated the magnitude of BMI-related underreporting for energy, protein, and potassium intake for the Dutch cohorts of the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: The study population consisted of 134 Dutch men and women, aged 21-71 years, who participated in a pilot of EPIC. Ratios of reported dietary intakes to biomarkers were used as measures for underreporting. Dietary intake was assessed by a food frequency questionnaire (FFQ) and repeated 24-hour dietary recalls. Biomarker for energy intake was calculated basal metabolic rate; for protein and potassium intake the biomarker was 24-hour urinary nitrogen and potassium excretion, respectively. The measures of underreporting were linearly regressed on BMI (in kg/m2). RESULTS: Significant negative regression coefficients were observed when regressing energy ratio on BMI with adjustment for physical activity (FFQ: beta = -0.04 for men, beta = -0.02 for women; 24-hour recalls: beta = -0.03 for men, beta = -0.04 for women). In men, a significant negative regression coefficient (beta = -0.03) was observed when regressing protein ratio on BMI; for the recalls however only after adjustment for age and education (beta = -0.02). In women, negative regression coefficients were also obtained, but for the FFQ only after exclusion of dieting women (both FFQ and 24-hour recalls: beta = -0.02). According to the recalls, but not the FFQ, a significant negative regression coefficient (beta = -0.02) was observed among women when regressing potassium ratio on BMI. CONCLUSIONS: In this Dutch population, BMI-dependent underreporting of 20-25% over the observed range of BMI is present for protein and energy, Further study on BMI-dependent underreporting of dietary intake in EPIC cohorts is warranted.

Adult↗
PubMed1998

Separate associations of waist and hip circumference with lifestyle factors.

OBJECTIVE: To study the associations of lifestyle factors with waist circumference 'Action Levels', hip circumference and body mass index. DESIGN: Cross-sectional study in a random sample of 5887 men and 7018 women aged 20-59 years, selected from the civil registries of Amsterdam, Maastricht and Doetinchem, The Netherlands. RESULTS: Results were compared to those in low health risk reference groups: non-smokers, occasional drinkers, highest educated, physically active, employed subjects, women who had no live births, or 20-29-year-olds. In multivariate logistic regression analysis, odds ratios (95% confidence interval) for having a waist above 'Action Level 2' (> or =102 cm in men, > or =88 cm in women) were significantly lower in smokers, and higher in heavy drinkers, inactive subjects, unemployed people, those educated below secondary level, women who had > or =3 live births, and older age. Mean waist-to-hip ratio adjusted for body mass index and age were higher in these groups. Residual analysis showed that the likelihood of having larger waist than expected from their body mass index was 1.2 times (1.1-1.4) in male smokers, 1.4 times (1.2-1.7) in male and 1.7 times (1.3-2.2) in female heavy drinkers, 1.6 times (1.5-1.8) in inactive men, and 1.3 times (1.1-1.5) in unemployed women. The risk of having smaller hips than expected from body mass index was 1.2 times (1.1-1.4) in male and 1.2 times (1.0-1.3) in female smokers, 1.2 times (1.1-1.3) in men and 1.1 times (1.0-1.2) in women who were inactive. CONCLUSIONS: Each lifestyle factor influences the size of waist and the hips differently, and understanding these influences is important for health promotion directed at the general public. Lifestyle modifications such as smoking cessation, reduced drinking, and a more physically active lifestyle should all be encouraged, leading to an overall healthier body shape.

Adult↗
PubMed1998

Undertreatment of hypertension in a population-based study in The Netherlands.

OBJECTIVE: To estimate the level of undertreatment of hypertension in a population-based study by taking into account the co-existence of additional cardiovascular risk factors in untreated hypertensives, uncontrolled blood pressure among pharmacologically treated hypertensives and within-person variability in blood pressure and total cholesterol. DESIGN: Cross-sectional. SETTING: Two population-based surveys on cardiovascular disease risk factors conducted during 1987-1995 in The Netherlands. PARTICIPANTS: 56 026 men and women aged 20-59 years. MAIN OUTCOME MEASURES: Prevalence of hypertension, of treatment and of undertreatment of hypertension. Undertreated hypertensives were those who were treated pharmacologically, but whose blood pressure was still elevated and those who inappropriately received no medication for the treatment of hypertension. RESULTS: During the past decade in The Netherlands, 30% of the hypertensive women and 47% of the hypertensive men aged 20-59 years were undertreated for hypertension. In both men and women treated pharmacologically, 42 and 29%, respectively, still had elevated blood pressure levels. Of those hypertensive men and women not treated pharmacologically, 53 and 34%, respectively, should have been treated when additional cardiovascular risk factors were taken into account Among those diagnosed but untreated for hypertension, 58 and 31% of the men and women, respectively, should have been treated pharmacologically. CONCLUSION: A considerable proportion of hypertensives were undertreated for hypertension. To decrease the undertreatment of hypertension, it is necessary to obtain better control of blood pressure in patients already being treated, increase the detection of hypertension and improve adherence to the current guidelines.

Adult↗
PubMed1998

Sex differences in antihypertensive drug use: determinants of the choice of medication for hypertension.

OBJECTIVE: To describe and explain sex differences in antihypertensive drug use. DESIGN AND METHODS: From 1987 to 1995, two cross-sectional population-based surveys of cardiovascular disease risk factors in The Netherlands were carried out among 56026 men and women aged 20-59 years. Polytomous logistic regression modelling was used to adjust for potential confounders of the association between sex and use of different antihypertensive drugs. RESULTS: The response rate was 40% for men and 46% for women. Of these respondents, 40% (1041) of the hypertensive men and 59% (1403) of the hypertensive women were being treated pharmacologically; 57% (595) of the treated men and 54% (760) of the treated women were on monotherapy for hypertension with a diuretic (men 14.8%, women 37.2%), a beta-blocker (men 59.0%, women 45.3%), a calcium antagonist (men 8.6%, women 5.0%) or an angiotensin converting enzyme inhibitor (men 17.7%, women 12.5%). Among those on monotherapy for hypertension, women were less likely than men to be using a beta-blocker [prevalence odds ratio (POR), female/male=0.34; 95% confidence interval (CI) 0.24-0.47], a calcium antagonist (POR=0.27, 95% CI 0.15-0.48) or an angiotensin converting enzyme inhibitor (POR=0.34, 95% CI 0.22-0.52) than a diuretic. These sex differences persisted after adjustment for all factors that could have influenced the choice of these antihypertensive drugs (indications and contra-indications for the four antihypertensive drug classes). The sex differences in antihypertensive drug use were smaller among hypertensives with a history of cardiovascular disease (adjusted PORs, female/male, for beta-blockers, calcium antagonists and ACE inhibitors, respectively, compared to diuretics were 0.80 with 95% CI 0.20-3.24, 0.40 with 95% CI 0.10-0.48 and 0.64 with 95% CI 0.12-3.39) than among those without such a history. CONCLUSIONS: The different patterns of antihypertensive drug use among hypertensive men and women seem irrational, and cannot be explained by factors known to influence antihypertensive drug choice. Among hypertensives with a history of cardiovascular disease, the sex differences were smaller than among those without such a history. Further research is required to explain the sex differences in the choice of antihypertensive drug by prescribers, and to investigate the consequences of these differences for long-term patient outcomes.

Adult↗
PubMed1998

Quality of life in relation to overweight and body fat distribution.

OBJECTIVES: This study quantified the impairment of quality of life attributable to body fatness by using the standardized SF-36 Health Survey. METHODS: Tertiles of waist circumference and body mass index (BMI) in 1885 men and 2156 women aged 20 to 59 years in the Netherlands in 1995 were compared. RESULTS: The odds ratios and 95% confidence intervals of subjects with the largest waist circumferences, compared with those in the lowest tertile, were 1.8 (1.3, 2.4) in men and 2.2 (1.7, 2.9) in women with difficulties in bending, kneeling, or stooping; 2.2 (1.4, 3.7) in men and 1.7 (1.2, 2.6) in women with difficulties in walking 500 m; and 1.3 (1.0, 1.9) in men and 1.5 (1.1, 1.9) in women with difficulties in lifting or carrying groceries. Anthropometric measures were less strongly associated with social functioning, role limitations due to physical or emotional problems, mental health, vitality, pain, or health change in 1 year. The relationship between quality of life measures and BMI were similar to those between quality of life measures and waist circumference. CONCLUSIONS: Large waist circumferences and high BMIs are more likely to be associated with impaired quality of life and disability affecting basic activities of daily living.

Activities of Daily Living↗
PubMed1997

The influences of height and age on waist circumference as an index of adiposity in adults.

OBJECTIVES: To assess the influences of height and age on the differences in waist circumference between individuals of different stature. SUBJECTS: 3319 males and 4358 females from four studies in the UK and the Netherlands. MEASUREMENTS: Waist circumference, body weight, height, and age. RESULTS: Linear regression analysis of log10 height as the independent variable on log10 waist as the dependent variable was used to determine the optimal index powers (OIP) (p) to minimize the influence of height in the relationships of waist/height(p). Six out of eight samples of men and women had OIP of height not significantly different from zero, with the remaining two groups had OIP between 0.15-0.58, indicating that height had very limited influence on the differences in waist circumference measurement between individuals. Age adjustment increased the relationship between waist and height, with OIP of 0.19-0.89 in men and 0.02-0.58 in women. Without age adjustment, height explained 0.3-3.5% and 0.1-2.5% variance in waist in men and in women respectively, and the corresponding variances were 0.4-7.5% in men and 0.0-2.6% in women with age adjustment. A similar analysis of weight and height showed the OIP of height in weight/height(p) ratio ranged from 1.32-2.25 in men, and 0.87-1.74 in women without age adjustment, and from 1.47-2.24 in men and 1.25-1.96 in women with age adjustment. CONCLUSION: Height and age had limited influences on the differences in waist between Caucasian subjects of different stature. Waist alone may be used to indicate adiposity or to reflect metabolic risk factors. In contrast, the influence of height on body weight is important.

Adult↗
PubMed1997

Differences in the association between smoking and relative body weight by level of education.

OBJECTIVE: To investigate differences in the association between smoking and relative body weight by sex, age group and level of education. DESIGN: Cross-sectional study. SUBJECTS: About 36,000 men and women who participated in the Monitoring Project on Cardiovascular Disease Risk Factors in the Netherlands in 1987-1991. RESULTS: The association between smoking and relative body weight differed by level of education. This difference was more pronounced among men than among women. Male heavy smokers had statistically significantly (P < 0.05) higher mean body mass index (BMI) than never smokers at high educational level, whereas they had a significantly lower mean BMI than never smokers at low educational level. In addition, ex-smokers had significantly higher mean BMI than never smokers in men with high education but not in men with low education nor in women. The difference in the association between smoking and relative body weight by educational level could not be explained by physical activity, fat intake or alcohol consumption nor by factors related to smoking behaviour. CONCLUSION: The association between smoking and relative body weight may differ between subgroups within one population. Therefore adjustment for these subgroups, for example for educational level, may be inappropriate in studies of the BMI-smoking relationship. Also, stopping smoking may have difference effects on weight in these subgroups.

Adult↗
PubMed1997

Predicting intra-abdominal fatness from anthropometric measures: the influence of stature.

OBJECTIVE: To investigate the influence of height on the relationships between the intra-abdominal fat and anthropometric measures. SUBJECTS: Twenty healthy female volunteers aged 20-51 y from Aberdeen, and 71 men and 34 women aged 19-85 y from Nijmegen, The Netherlands. OUTCOME MEASURES: Intra-abdominal fat volumes by magnetic resonance imaging (MRI) in Aberdeen and cross-sectional areas at L4-L5 level by computerised tomography (CT) in Nijmegen, height, body mass index (BMI), waist circumference, waist sagittal and transverse diameters, waist to hip ratio, and skinfolds. RESULTS: In the MRI study the women with BMI 20-33 kg/m2, waist circumference 62-97 cm, height 148-172 cm, and intra-abdominal fat volume 0.07-2.66 kg, waist circumference gave the highest correlation of simple indices with intra-abdominal fat volume, explaining 77.8% of variance. Single cross-sectional MRI cuts predicted volume with r = 0.94-0.99. Height in various levels of index power was not related to waist circumference, waist diameters, BMI, or skinfolds and did not improve prediction of intra-abdominal fat volume or of cross-sectional intra-abdominal fat area at any level. The CT study of men and women with BMI 18-32 kg/m2 and 19-38 kg/m2, waist circumference 71-112 cm and 74-125 cm, height 158-197 cm and 151-182 cm, and intra-abdominal fat area 13-274 cm2 and 19-221 cm2 respectively, height also had little influence on the relationships of intra-abdominal fat area with waist circumference or with any other indices of adiposity in linear or quadratic models. Compared to younger subjects, intra-abdominal fat area was higher in older subjects for a given waist circumference. CONCLUSIONS: Height does not importantly influence the differences in measures of adiposity or intra-abdominal fat volume in women, or intra-abdominal fat area in both sexes. Age does influence the prediction of intra-abdominal fat from waist circumference, but waist circumference alone has a predictable simple relationship with intra-abdominal fat volume or area, which is likely to relate to the prediction of health risk for health promotion.

Abdomen↗
PubMed1997

The prevalence of low back pain and associations with body fatness, fat distribution and height.

OBJECTIVES: To examine the associations of low back pain symptoms with waist circumference, height, waist to hip ratio and body mass index, and to test the interactions between (1) waist circumference and height, and (2) waist to hip ratio and body mass index. SETTING: Cross-sectional study set in The Netherlands of a random sample of 5887 men and 7018 women aged 20-60 y. RESULTS: The prevalences of low back pain in men and women in the past 12 months were 46% and 52%, of whom 17% and 21% had low back pain for a total of 12 or more weeks, and 13% and 18% had symptoms suggestive of intervertebral disc herniation. After adjustments for age, smoking and education, more women in the highest tertile of waist circumference reported low back pain in the past 12 months (odds ratio = 1.2, 95% confidence interval: 1.1-1.4), low back pain for a total of 12 or more weeks (odds ratio = 1.5, 95% confidence interval: 1.3-1.8), and intervertebral disc herniation symptoms (odds ratio = 1.3, 95% confidence interval: 1.1-1.6) than women in the lowest waist tertile. Corresponding values of low back pain symptoms for women with high body mass index or high waist to hip ratio were similar to those with high waist. There were no significant differences between men in different tertiles of waist, waist to hip ratio or body mass index reporting low back pain symptoms. Tallest subjects did not report low back pain symptoms more often than shortest subjects. There was no significant interactions between waist and height or between waist to hip ratio and body mass index on low back pain symptoms. CONCLUSIONS: Women who are overweight or with a large waist have a significantly increased likelihood of low back pain. There are no significant interactions between waist and height, or waist to hip ratio and body mass index on low back pain symptoms.

Adipose Tissue↗
PubMed1997

Visceral fat in relation to health: is it a major culprit or simply an innocent bystander?

The aim of this review is to look critically at the widely accepted notion that visceral fat accumulation is the main determinant of obesity related diseases. Most of the epidemiological evidence is based on anthropometric indicators of fatness and fat distribution and their implications for visceral fat accumulation may not be unequivocal. In most cross-sectional studies in which visceral fat is associated with the level of risk factors or presence of disease, no adjustment is made for potential confounders. There are potential confounders at different levels of the causal chains linking visceral fat to health. Firstly, there are aspects of body composition or fat depots associated with visceral fat accumulation such as total body fat or total subcutaneous fat. Total and subcutaneous fat are, by themselves, potentially strong determinants for metabolic disturbances and disease. Secondly, there are behavioural factors (for example smoking, alcohol consumption, physical activity, dietary habits) which have been found to be associated with both the amount of visceral fat and health outcomes. Thirdly, there are hormonal mechanisms (adrenal and gonadal steroids as well as growth hormone) which may affect both the accumulation of visceral fat as well as the development of diseases. Finally, even if associations between visceral fat and risk factors or presence of diseases would be firmly established, the causality of the observed associations may not always be easy to interpret. Prospective studies are needed with appropriate control of potential confounding variables. It is concluded that, based on the current evidence, it is difficult to quantify the independent contribution of visceral fat to the development of a variety of chronic diseases.

Adipose Tissue↗
PubMed1997

Reproducibility of fat area measurements in young, non-obese subjects by computerized analysis of magnetic resonance images.

OBJECTIVE: To assess reproducibility, expressed as both inter-observer variability and intra-observer variability, of fat area measurements on images obtained by magnetic resonance (MR); to compare variability between fat area measurements, calculated from a single image per body region and from the average fat area of three images, and to determine reproducibility of image acquisition at the abdominal level. SUBJECTS: Thirty young, non-obese subjects (reproducibility of image analysis) and nine young, non-obese subjects (reproducibility of image acquisition). METHODS: Three MR images at the level of the abdomen (in 30 subjects) and at the level of the hip and thigh (in 14 of them). Quantification of subcutaneous fat depots (abdomen, hip and thigh) and visceral fat depots using an image-analyzing computer program. Assessment of variability of image analysis for fat area measurements between two observers and within observers. Assessment of reproducibility of image acquisition at the abdominal level (in nine subjects). RESULTS: Subcutaneous fat areas in all body regions were quantified with coefficients of variation (CV) ranging from only 2.1%-4.9%. By contrast, visceral fat area measurements showed markedly higher CVs (range: 9.4%-17.6%). Moreover, relative variability was much larger in small visceral fat areas (CVs up to 25.6%). The majority of CVs, calculated for intra-observer variability and calculated from the average fat area measurements of three images, was lower than calculated for inter-observer variability and for one single image, respectively. In particular, for the visceral fat depot, this reduction in variability had practical consequences for the number of subjects required for a study. Variation of repeated image acquisition was in the same range as variation of repeated measurements on the same image. CONCLUSION: One image per body site is sufficient to obtain a reliable estimate of subcutaneous fat depots. For estimations of the visceral fat depot, the average area measurements of three images reduces variability and increases statistical power. The availability of one single experienced observer during a study adds to accuracy.

Abdomen↗
PubMed1997

Narrow hips and broad waist circumferences independently contribute to increased risk of non-insulin-dependent diabetes mellitus.

OBJECTIVES: Patients with non-insulin-dependent diabetes mellitus (NIDDM) have been shown to be more obese and have higher waist-to-hips circumference ratios compared to nondiabetics. In this study, we tried to dissociate obesity, waist and hip circumference from NIDDM. DESIGN: A cross-sectional population-based case-control study. SETTING: General population. SUBJECTS CONTROLS: 5887 men and 7018 women, aged 20-59 years, without known diabetes or hyperglycaemia. CASES: 93 men and 66 women were diagnosed with NIDDM. MAIN OUTCOME MEASURES: We predicted waist and hips' circumference from the body mass index, weight/height2, (BMI) on the basis of linear regression. Differences between observed and expected values (residuals) of waist and hip circumference were categorized into tertiles. The relative odds of having NIDDM in tertiles of waist and hip residuals (middle tertile as reference) were calculated by multiple logistic regression analysis adjusted for each other and for age, smoking, physical activity, alcohol consumption and education. RESULTS: NIDDM was most prevalent in men and women who had larger waists and in those who had smaller hip circumferences than expected from their BMI. Adjusted odds ratios (95% CI) for NIDDM were 2.9 (1.6-5.1) in men and 2.8 (1.5-5.1) in women who had a larger than expected waist, and were 3.7 (2.1-6.5) in men and 2.1 (1.1-3.8) in women who had smaller than expected hips. CONCLUSIONS: Our findings suggest that diabetics have larger waists and smaller hips compared to nondiabetics, irrespective of their degree of obesity, age and life-style factors. One possibility is that besides abdominal fatness, peripheral muscle atrophy is one of the factors associated with NIDDM.

Abdomen↗
PubMed1997

Time trends in obesity: an epidemiological perspective.

The average prevalence of obesity (BMI > 30 kg/m2) among European centers participating in the WHO-MONICA study between 1983 and 1986 was about 15% in men and 22% in women Prevalence figures ranged in men from 7% in Gothenburg and 22% in Lithuania and in women from 9% to 45% in the same places. Some monitoring projects or repeated surveys suggest that the prevalence of obesity has been increasing during the past 15 years in some European countries. A closer look at data from The Netherlands suggest that average weight increase in the order of about 1 kilo can be responsible for quite dramatic increases in the prevalence of obesity. This suggest that only small changes in the daily caloric balance may be sufficient to increase the number of obese subjects in populations. In The Netherlands a decrease in energy intake and fat consumption was observed between 1987 and 1993 and smoking rates remained relatively stable. This could imply that reductions in energy expenditure are the main factors responsible for the increase in the prevalence of obesity. Since the increase in the prevalence of obesity seems to occur particularly in younger age-groups, the consequences of the increase in the prevalence of obesity only become apparent many years later. Especially chronic conditions such as arthritis or conditions related to obesity but occurring later in life such as cerebrovascular accidents, chronic heart failure or breast cancer in women. The rising prevalence of non-insulin dependent diabetes mellitus may be one of the first signs of the increasing problem of obesity in European countries.

Adolescent↗
PubMed1997

Assessing obesity: classification and epidemiology.

Obesity is generally defined as a body mass index (BMI) of 30 kg/m2 and higher. Overweight is defined as a BMI between 25 and 30 kg/m2. The prevalence varies considerably between countries, and between regions within countries. It is estimated that more than half of adults aged 35-65 living in Europe are either overweight or obese. Overweight is more common among men than among women but obesity is more common among women. The prevalence of obesity in Europe is probably in the order of 10-20% in men and 15-25% in adult women. In most European countries who have reliable data on time-trends the prevalence of obesity seems to be increasing. In most European countries, obesity is usually inversely associated with socio-economic status, particularly among women. New classifications of overweight may be based on cut-off points for simple anthropometric measures which reflects both total adiposity as well as abdominal fatness.

Adipose Tissue↗
PubMed1997

Sex differences in the pharmacological treatment of hypertension: a review of population-based studies.

OBJECTIVE: To summarize all available literature on sex differences in the pharmacological treatment of hypertension with respect to the percentage of hypertensive patients treated pharmacologically and the selection of antihypertensive drugs. The influences of the calendar period, age, definition of hypertension, prevalence of hypertension and country on these sex differences were examined. DATA IDENTIFICATION: A secondary analysis of data from 46 population-based studies in 22 countries on the prevalence of pharmacologically treated hypertension was conducted to estimate sex ratios for the prevalence of drug treatment for hypertension. RESULT: Overall, women with hypertension were 1.33-fold [95% confidence interval (CI) 1.32-1.34] more likely to be treated pharmacologically for hypertension than were hypertensive men. With increasing age, the female: male ratio for pharmacological treatment of hypertension decreased from 2.26 (95% CI 1.56-3.27) at ages 20-29 years to 1.22 (95% CI 1.11-1.34) at ages 60-69 years. In all countries more women than men were treated for hypertension, with the biggest difference observed in the USSR (1983-1986), where about twice as many women as men were treated for hypertension. Women more frequently used diuretics, whereas men more often used beta-blockers, angiotensin converting enzyme inhibitors and calcium antagonists. CONCLUSIONS: Hypertensive women are more often treated for hypertension than hypertensive men and their pattern of use of antihypertensive drugs differs from that of men. Further research is required in order to explain sex differences in the treatment of hypertension with respect to the prevalence of pharmacological treatment of hypertension and choice of antihypertensive drugs, and to investigate the consequences of this difference for long-term outcomes.

Adult↗