Differential effects of antihypertensive agents on electrocardiographic voltage: results from the Appropriate Blood Pressure Control in Diabetes (ABCD) trial
Serial decline in electrocardiographic voltage in patients with increased left ventricular mass has been associated with a lower risk of cardiovascular events. We studied 468 patients with diabetes mellitus and hypertension in the Appropriate Blood Pressure Control in Diabetes (ABCD) trial. Patients...
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| Veröffentlicht in: | The American heart journal 2003-06, Vol.145 (6), p.993-998 |
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| creator | Havranek, Edward P Esler, Anne Estacio, Raymond O Mehler, Philip S Schrier, Robert W |
| description | Serial decline in electrocardiographic voltage in patients with increased left ventricular mass has been associated with a lower risk of cardiovascular events.
We studied 468 patients with diabetes mellitus and hypertension in the Appropriate Blood Pressure Control in Diabetes (ABCD) trial. Patients were randomized in a stratified design to receive initial treatment with either enalapril or nisoldipine and to either intensive or moderate treatment goals. We measured an electrocardiographic index for increased left ventricular mass, the adjusted Cornell voltage, serially by treatment group. The association between changes in electrocardiographic voltage and cardiovascular events was defined with Cox proportional hazards analysis.
In 5 years of follow-up, the decline in adjusted Cornell voltage was significantly greater for patients treated with enalapril than for patients treated with nisoldipine (repeated measures analysis of variance
P = .002). In the Cox proportional hazards model, treatment assignment (enalapril vs nisoldipine) was the strongest predictor of cardiovascular events, but the presence of coronary disease at baseline, the duration of diabetes mellitus, and change in voltage were also independent predictors of cardiovascular events.
In the ABCD study, enalapril treatment was associated with a lower risk of myocardial infarction. The reduction in left ventricular mass as reflected by diminished electrocardiographic voltage may explain some, but not all, of the effect of enalapril in this study. |
| doi_str_mv | 10.1016/S0002-8703(02)94780-0 |
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We studied 468 patients with diabetes mellitus and hypertension in the Appropriate Blood Pressure Control in Diabetes (ABCD) trial. Patients were randomized in a stratified design to receive initial treatment with either enalapril or nisoldipine and to either intensive or moderate treatment goals. We measured an electrocardiographic index for increased left ventricular mass, the adjusted Cornell voltage, serially by treatment group. The association between changes in electrocardiographic voltage and cardiovascular events was defined with Cox proportional hazards analysis.
In 5 years of follow-up, the decline in adjusted Cornell voltage was significantly greater for patients treated with enalapril than for patients treated with nisoldipine (repeated measures analysis of variance
P = .002). In the Cox proportional hazards model, treatment assignment (enalapril vs nisoldipine) was the strongest predictor of cardiovascular events, but the presence of coronary disease at baseline, the duration of diabetes mellitus, and change in voltage were also independent predictors of cardiovascular events.
In the ABCD study, enalapril treatment was associated with a lower risk of myocardial infarction. The reduction in left ventricular mass as reflected by diminished electrocardiographic voltage may explain some, but not all, of the effect of enalapril in this study.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/S0002-8703(02)94780-0</identifier><identifier>PMID: 12796754</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adult ; Aged ; Antihypertensive Agents - therapeutic use ; Arterial hypertension. Arterial hypotension ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Pressure - drug effects ; Blood Pressure - physiology ; Body mass index ; Calcium Channel Blockers ; Cardiology. Vascular system ; Clinical manifestations. Epidemiology. Investigative techniques. Etiology ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - physiopathology ; Diabetic Angiopathies - drug therapy ; Diabetic Angiopathies - physiopathology ; Double-Blind Method ; Drug therapy ; Electrocardiography ; Enalapril - therapeutic use ; Female ; Heart attacks ; Humans ; Hypertension - drug therapy ; Hypertension - physiopathology ; Hypertrophy, Left Ventricular - drug therapy ; Hypertrophy, Left Ventricular - physiopathology ; Male ; Medical sciences ; Middle Aged ; Nisoldipine - therapeutic use ; Proportional Hazards Models ; Prospective Studies</subject><ispartof>The American heart journal, 2003-06, Vol.145 (6), p.993-998</ispartof><rights>2003 Elsevier Science Inc.</rights><rights>2003 INIST-CNRS</rights><rights>Copyright Elsevier Limited Jun 2003</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-6ff8c932899a392821130a9935717fbaef82effa7b9c600ee16a15aee8d9da003</citedby><cites>FETCH-LOGICAL-c419t-6ff8c932899a392821130a9935717fbaef82effa7b9c600ee16a15aee8d9da003</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1549952494?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14873539$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12796754$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Havranek, Edward P</creatorcontrib><creatorcontrib>Esler, Anne</creatorcontrib><creatorcontrib>Estacio, Raymond O</creatorcontrib><creatorcontrib>Mehler, Philip S</creatorcontrib><creatorcontrib>Schrier, Robert W</creatorcontrib><creatorcontrib>Appropriate Blood Pressure Control in Diabetes Trial</creatorcontrib><title>Differential effects of antihypertensive agents on electrocardiographic voltage: results from the Appropriate Blood Pressure Control in Diabetes (ABCD) trial</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Serial decline in electrocardiographic voltage in patients with increased left ventricular mass has been associated with a lower risk of cardiovascular events.
We studied 468 patients with diabetes mellitus and hypertension in the Appropriate Blood Pressure Control in Diabetes (ABCD) trial. Patients were randomized in a stratified design to receive initial treatment with either enalapril or nisoldipine and to either intensive or moderate treatment goals. We measured an electrocardiographic index for increased left ventricular mass, the adjusted Cornell voltage, serially by treatment group. The association between changes in electrocardiographic voltage and cardiovascular events was defined with Cox proportional hazards analysis.
In 5 years of follow-up, the decline in adjusted Cornell voltage was significantly greater for patients treated with enalapril than for patients treated with nisoldipine (repeated measures analysis of variance
P = .002). In the Cox proportional hazards model, treatment assignment (enalapril vs nisoldipine) was the strongest predictor of cardiovascular events, but the presence of coronary disease at baseline, the duration of diabetes mellitus, and change in voltage were also independent predictors of cardiovascular events.
In the ABCD study, enalapril treatment was associated with a lower risk of myocardial infarction. The reduction in left ventricular mass as reflected by diminished electrocardiographic voltage may explain some, but not all, of the effect of enalapril in this study.</description><subject>Adult</subject><subject>Aged</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Arterial hypertension. Arterial hypotension</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Pressure - drug effects</subject><subject>Blood Pressure - physiology</subject><subject>Body mass index</subject><subject>Calcium Channel Blockers</subject><subject>Cardiology. Vascular system</subject><subject>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - physiopathology</subject><subject>Diabetic Angiopathies - drug therapy</subject><subject>Diabetic Angiopathies - physiopathology</subject><subject>Double-Blind Method</subject><subject>Drug therapy</subject><subject>Electrocardiography</subject><subject>Enalapril - therapeutic use</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - physiopathology</subject><subject>Hypertrophy, Left Ventricular - drug therapy</subject><subject>Hypertrophy, Left Ventricular - physiopathology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nisoldipine - therapeutic use</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqF0d1qFDEUB_BBFLtWH0EJiNJejCaTzGTijWx3_YKCgnodspmTbkp2siaZhT5M37Vnu4sFb7zK1y-Hk_yr6iWj7xhl3fuflNKm7iXlZ7Q5V0L2tKaPqhmjStadFOJxNftLTqpnOV_jsmv67ml1whqpOtmKWXW79M5BgrF4Ewjg3JZMoiMGd9Y3W0gFxux3QMwVIjwaCQREKVqTBh-vktmuvSW7GAqSDyRBngJCl-KGlDWQ-Xab4jZ5U4BchBgH8gNNnhKQRRyxUCB-JEtvVlAgk7P5xWJ5TgpeCM-rJ86EDC-O42n1-_OnX4uv9eX3L98W88vaCqZK3TnXW8WbXinDVdM3jHFqlOKtZNKtDLi-wacZuVK2oxSAdYa1BqAf1GAo5afV20Nd7PTPBLnojc8WQjAjxClryXnXCdUgfP0PvI5TGrE3zVqhVNsIJVC1B2VTzDmB0_j8jUk3mlG9T0_fp6f30Wgc79PT-zZeHatPqw0MD7eOcSF4cwQmWxNcMqP1-cGJXvKWK3QfDw7w03Yeks7Ww2hh8Amz00P0_2nlDtzSuOw</recordid><startdate>20030601</startdate><enddate>20030601</enddate><creator>Havranek, Edward P</creator><creator>Esler, Anne</creator><creator>Estacio, Raymond O</creator><creator>Mehler, Philip S</creator><creator>Schrier, Robert W</creator><general>Mosby, Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20030601</creationdate><title>Differential effects of antihypertensive agents on electrocardiographic voltage: results from the Appropriate Blood Pressure Control in Diabetes (ABCD) trial</title><author>Havranek, Edward P ; Esler, Anne ; Estacio, Raymond O ; Mehler, Philip S ; Schrier, Robert W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-6ff8c932899a392821130a9935717fbaef82effa7b9c600ee16a15aee8d9da003</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Arterial hypertension. 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Etiology</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - physiopathology</topic><topic>Diabetic Angiopathies - drug therapy</topic><topic>Diabetic Angiopathies - physiopathology</topic><topic>Double-Blind Method</topic><topic>Drug therapy</topic><topic>Electrocardiography</topic><topic>Enalapril - therapeutic use</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Hypertension - drug therapy</topic><topic>Hypertension - physiopathology</topic><topic>Hypertrophy, Left Ventricular - drug therapy</topic><topic>Hypertrophy, Left Ventricular - physiopathology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nisoldipine - therapeutic use</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Havranek, Edward P</creatorcontrib><creatorcontrib>Esler, Anne</creatorcontrib><creatorcontrib>Estacio, Raymond O</creatorcontrib><creatorcontrib>Mehler, Philip S</creatorcontrib><creatorcontrib>Schrier, Robert W</creatorcontrib><creatorcontrib>Appropriate Blood Pressure Control in Diabetes Trial</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Havranek, Edward P</au><au>Esler, Anne</au><au>Estacio, Raymond O</au><au>Mehler, Philip S</au><au>Schrier, Robert W</au><aucorp>Appropriate Blood Pressure Control in Diabetes Trial</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Differential effects of antihypertensive agents on electrocardiographic voltage: results from the Appropriate Blood Pressure Control in Diabetes (ABCD) trial</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2003-06-01</date><risdate>2003</risdate><volume>145</volume><issue>6</issue><spage>993</spage><epage>998</epage><pages>993-998</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Serial decline in electrocardiographic voltage in patients with increased left ventricular mass has been associated with a lower risk of cardiovascular events.
We studied 468 patients with diabetes mellitus and hypertension in the Appropriate Blood Pressure Control in Diabetes (ABCD) trial. Patients were randomized in a stratified design to receive initial treatment with either enalapril or nisoldipine and to either intensive or moderate treatment goals. We measured an electrocardiographic index for increased left ventricular mass, the adjusted Cornell voltage, serially by treatment group. The association between changes in electrocardiographic voltage and cardiovascular events was defined with Cox proportional hazards analysis.
In 5 years of follow-up, the decline in adjusted Cornell voltage was significantly greater for patients treated with enalapril than for patients treated with nisoldipine (repeated measures analysis of variance
P = .002). In the Cox proportional hazards model, treatment assignment (enalapril vs nisoldipine) was the strongest predictor of cardiovascular events, but the presence of coronary disease at baseline, the duration of diabetes mellitus, and change in voltage were also independent predictors of cardiovascular events.
In the ABCD study, enalapril treatment was associated with a lower risk of myocardial infarction. The reduction in left ventricular mass as reflected by diminished electrocardiographic voltage may explain some, but not all, of the effect of enalapril in this study.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>12796754</pmid><doi>10.1016/S0002-8703(02)94780-0</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Antihypertensive Agents - therapeutic use Arterial hypertension. Arterial hypotension Biological and medical sciences Blood and lymphatic vessels Blood Pressure - drug effects Blood Pressure - physiology Body mass index Calcium Channel Blockers Cardiology. Vascular system Clinical manifestations. Epidemiology. Investigative techniques. Etiology Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - physiopathology Diabetic Angiopathies - drug therapy Diabetic Angiopathies - physiopathology Double-Blind Method Drug therapy Electrocardiography Enalapril - therapeutic use Female Heart attacks Humans Hypertension - drug therapy Hypertension - physiopathology Hypertrophy, Left Ventricular - drug therapy Hypertrophy, Left Ventricular - physiopathology Male Medical sciences Middle Aged Nisoldipine - therapeutic use Proportional Hazards Models Prospective Studies |
| title | Differential effects of antihypertensive agents on electrocardiographic voltage: results from the Appropriate Blood Pressure Control in Diabetes (ABCD) trial |
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