Hypertension (HTN) is the most common co-morbidity in the world, and its sequelae, heart failure (HF) is one of most common causes of mortality and morbidity in the world. Current understanding of pathophysiology and management of HTN in HF is mainly based on studies, which have mainly included whites. Among racial groups, African-American adults have the highest rates ( ) of hypertension in the world and are more resistant to treatment. There is an emerging consensus on the significance of racial disparities in the pathophysiology and treatment options of hypertension and heart failure. However, African Americans had been underrepresented in all the trials until the initiation of the A-HEFT trial. Since the recognition of obstructive sleep apnea (OSA) as an important medical condition, large clinical trials have shown benefits of OSA treatment among patients with HTN and HF. This paper focuses on the pathophysiology, causes of secondary hypertension, and treatment of hypertension among African-American patients with heart failure. There is increasing need for randomized clinical trials testing innovative treatment options for African-American patients. 1. Introduction Hypertension (HTN) is the most common comorbidity in the world with significant public health implications [1, 2]. The overall U.S. prevalence of hypertension among adults ages ≥18 years in 2005–2008 was 30.9% and was highest among persons ages ≥65 years (69.7%) [3] and non-Hispanic blacks (44%) [4]. The American Heart Association estimates that the incurred costs of hypertension are more than $93.5？billion per year, and that cardiovascular disease and stroke for which HTN is the predominant risk factor, account for 17% of the total annual health expenditures in the United States [5]. Hypertension and its sequelae, heart failure (HF) [6], are a progressive disease. Evidence shows that less than half of patients with heart failure survive five years (after diagnosis), and less than a quarter of them live ten years after their initial diagnosis [7]. The incidence is about 550,000 each year in the United States. Framingham Heart Study showed that hypertensive patients were more likely to develop heart failure (142 cases of HF detected during the first 16 years of followup) than those who were normotensive [8]. The lifetime risk for development of HF among people with blood pressure (BP) >160/90？mm？Hg is double that of those with BP <140/90？mm？Hg. Heart failure in comparison to the most prevalent gender malignancies (bowel cancer in men and breast cancer in women), was associated with worse
References
[1]
P. M. Kearney, M. Whelton, K. Reynolds, P. Muntner, P. K. Whelton, and J. He, “Global burden of hypertension: analysis of worldwide data,” Lancet, vol. 365, no. 9455, pp. 217–223, 2005.
[2]
M. Ezzati, A. D. Lopez, A. Rodgers, H. S. Vander, and C. J. L. Murray, “Selected major risk factors and global and regional burden of disease,” Lancet, vol. 360, no. 9343, pp. 1347–1360, 2002.
[3]
“Vital signs: prevalence, treatment, and control of hypertension—United States, 1999–2002 and 2005–2008,” Morbidity and Mortality Weekly Report, vol. 60, no. 4, pp. 103–108, 2011.
[4]
V. L. Roger, A. S. Go, D. M. Lloyd-Jones et al., “Heart disease and stroke statistics-2011 update: a report from the American Heart Association,” Circulation, vol. 123, no. 4, pp. e18–e19, 2011.
[5]
P. A. Heidenreich, J. G. Trogdon, O. A. Khavjou et al., “Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association,” Circulation, vol. 123, no. 8, pp. 933–944, 2011.
[6]
D. Levy, M. G. Larson, R. S. Vasan, W. B. Kannel, and K. K. L. Ho, “The progression from hypertension to congestive heart failure,” Journal of the American Medical Association, vol. 275, no. 20, pp. 1557–1562, 1996.
[7]
M. R. Jonovich and J. D. Bisognano, “Management of hypertension in chronic heart failure,” Manual of Heart Failure Management, pp. 1–15, 2009.
[8]
W. B. Kannel, W. P. Castelli, P. M. McNamara, P. A. McKee, and M. Feinleib, “Role of blood pressure in the development of congestive heart failure. The Framingham study,” New England Journal of Medicine, vol. 287, no. 16, pp. 781–787, 1972.
[9]
S. Stewart, K. MacIntyre, D. J. Hole, S. Capewell, and J. J. V. McMurray, “More “malignant” than cancer? Five-year survival following a first admission for heart failure,” European Journal of Heart Failure, vol. 3, no. 3, pp. 315–322, 2001.
[10]
J. A. Franciosa, K. C. Ferdinand, and C. W. Yancy, “Treatment of heart failure in African Americans: a consensus statement,” Congestive Heart Failure, vol. 16, no. 1, pp. 27–38, 2010.
[11]
W. C. Cushman, C. E. Ford, P. T. Einhorn et al., “Blood pressure control by drug group in the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT),” Journal of Clinical Hypertension, vol. 10, no. 10, pp. 751–760, 2008.
[12]
W. C. Cushman, C. E. Ford, J. A. Cutler et al., “Success and predictors of blood pressure control in diverse North American settings: the antihypertensive and lipid-lowering treatment to prevent heart attact trial (ALLHAT),” Journal of Clinical Hypertension, vol. 4, no. 6, pp. 393–404, 2002.
[13]
A. V. Chobanian, G. L. Bakris, H. R. Black et al., “The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report,” Journal of the American Medical Association, vol. 289, no. 19, pp. 2560–2572, 2003.
[14]
C. W. Yancy, “Heart failure in African Americans,” American Journal of Cardiology, vol. 96, no. 7, pp. 3i–12i, 2005.
[15]
P. M. Okin, S. E. Kjeldsen, B. Dahlof, and R. B. Devereux, “Racial differences in incident heart failure during antihypertensive therapy,” Circadian Cardiovascular Quality Outcomes, vol. 4, no. 2, pp. 157–164, 2011.
[16]
L. S. Evangelista, K. Dracup, and L. V. Doering, “Racial differences in treatment-seeking delays among heart failure patients,” Journal of Cardiac Failure, vol. 8, no. 6, pp. 381–386, 2002.
[17]
J. A. Vita, “Nitric oxide and vascular reactivity in African American patients with hypertension,” Journal of Cardiac Failure, vol. 9, no. 5, pp. S199–S204, 2003.
[18]
M. Jessup, W. T. Abraham, D. E. Casey et al., “2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation,” Circulation, vol. 119, no. 14, pp. 1977–2016, 2009.
[19]
J. Loscalzo and G. Welch, “Nitric oxide and its role in the cardiovascular system,” Progress in Cardiovascular Diseases, vol. 38, no. 2, pp. 87–104, 1995.
[20]
M. R. Weir, J. M. Gray, R. Paster, and E. Saunders, “Differing mechanisms of action of angiotensin-converting enzyme inhibition in black and white hypertensive patients,” Hypertension, vol. 26, no. 1, pp. 124–130, 1995.
[21]
C. Cardillo, C. M. Kilcoyne, R. O. Cannon, and J. A. Panza, “Racial differences in nitric oxide-mediated vasodilator response to mental stress in the forearm circulation,” Hypertension, vol. 31, no. 6, pp. 1235–1239, 1998.
[22]
K. M. Small, L. E. Wagoner, A. M. Levin, S. L. R. Kardia, and S. B. Liggett, “Synergistic polymorphisms of β- and α-adrenergic receptors and the risk of congestive heart failure,” New England Journal of Medicine, vol. 347, no. 15, pp. 1135–1142, 2002.
[23]
S. A. Hunt, W. T. Abraham, M. H. Chin et al., “ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society,” Circulation., vol. 112, no. 12, pp. e154–e235, 2005.
[24]
J. L. Probstfield, “Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP),” Journal of the American Medical Association, vol. 265, no. 24, pp. 3255–3264, 1991.
[25]
“Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg,” Journal of the American Medical Association, vol. 202, no. 11, pp. 1028–1034, 1967.
[26]
“Effects of treatment on morbidity in hypertension—II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg,” Journal of the American Medical Association, vol. 213, no. 7, pp. 1143–1152, 1970.
[27]
B. Dahlof, L. H. Lindholm, L. Hansson, B. Schersten, T. Ekbom, and P. O. Wester, “Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension),” Lancet, vol. 338, no. 8778, pp. 1281–1285, 1991.
[28]
J. N. Cohn, D. G. Archibald, and S. Ziesche, “Effect of vasodilator therapy on mortality in chronic congestive heart failure: results of a Veterans Administration Cooperative Study,” New England Journal of Medicine, vol. 314, no. 24, pp. 1547–1552, 1986.
[29]
K. Swedberg, U. Idanpaan-Heikkila, and J. Remes, “Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS),” New England Journal of Medicine, vol. 316, no. 23, pp. 1429–1435, 1987.
[30]
S. Yusuf, “Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure,” New England Journal of Medicine, vol. 325, no. 5, pp. 293–302, 1991.
[31]
M. Packer, M. R. Bristow, J. N. Cohn et al., “The effect of carvedilol on morbidity and mortality in patients with chronic heart failure,” New England Journal of Medicine, vol. 334, no. 21, pp. 1349–1355, 1996.
[32]
A. Hjalmarson, S. Goldstein, B. Fagerberg et al., “Effect of metoprolol CR/XL in chronic heart failure: metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF),” Lancet, vol. 353, no. 9169, pp. 2001–2007, 1999.
[33]
H. J. Dargie and P. Lechat, “The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial,” Lancet, vol. 353, no. 9146, pp. 9–13, 1999.
[34]
B. Pitt, F. Zannad, W. J. Remme, R. Cody, A. Castaigne, and A. Perez, “The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators,” The New England Journal of Medicine, vol. 341, no. 10, pp. 709–717, 1999.
[35]
J. He, P. K. Whelton, L. J. Appel, J. Charleston, and M. J. Klag, “Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension,” Hypertension, vol. 35, no. 2, pp. 544–549, 2000.
[36]
U.S. Department of Agriculture and U.S. Department of Health and Human Services, Dietary Guidelines for Americans, 2010, U.S. Government Printing Office, Washington, DC, USA, 7th edition, 2011.
[37]
S. K. Gao, A. L. Fitzpatrick, B. Psaty et al., “Suboptimal nutritional intake for hypertension control in 4 ethnic groups,” Archives of Internal Medicine, vol. 169, no. 7, pp. 702–707, 2009.
[38]
F. M. Sacks, L. P. Svetkey, W. M. Vollmer et al., “Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (dash) diet,” New England Journal of Medicine, vol. 344, no. 1, pp. 3–10, 2001.
[39]
N. R. Cook, J. A. Cutler, E. Obarzanek et al., “Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP),” British Medical Journal, vol. 334, no. 7599, pp. 885–888, 2007.
[40]
L. J. Appel, “Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial,” Journal of the American Medical Association, vol. 289, no. 16, pp. 2083–2093, 2003.
[41]
G. Specchia, S. De Servi, A. Scirè et al., “Interaction between exercise training and ejection fraction in predicting prognosis after a first myocardial infarction,” Circulation, vol. 94, no. 5, pp. 978–982, 1996.
[42]
S. P. Whelton, A. Chin, X. Xin, and J. He, “Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials,” Annals of Internal Medicine, vol. 136, no. 7, pp. 493–503, 2002.
[43]
M. Scisney-Matlock, H. B. Bosworth, J. N. Giger et al., “Strategies for implementing and sustaining therapeutic lifestyle changes as part of hypertension management in African Americans,” Postgraduate Medicine, vol. 121, no. 3, pp. 147–159, 2009.
[44]
C. J. Murrock and F. A. Gary, “A culturally-specific dance intervention to increase functional capacity in African American women,” Journal of Cultural Diversity, vol. 15, no. 4, pp. 168–173, 2008.
[45]
National Center for Health Statistics. National Health and Nutrition Examination Survey 2005-2006, http://www.cdc.gov/nchs/about/major/nhanes/nhanes2005-2006/nhanes05_06.htm.
[46]
J. E. Mitchell, K. C. Ferdinand, K. E. Watson et al., “Treatment of heart failure in African Americans—a call to action,” Journal of the National Medical Association, vol. 103, no. 2, pp. 86–98, 2011.
[47]
A. L. Taylor, S. Ziesche, C. Yancy et al., “Combination of isosorbide dinitrate and hydralazine in blacks with heart failure,” New England Journal of Medicine, vol. 351, no. 20, pp. 2049–2141, 2004.
[48]
B. M. Psaty, N. L. Smith, D. S. Siscovick et al., “Health outcomes associated with antihypertensive therapies used as first-line agents: a systematic review and meta-analysis,” Journal of the American Medical Association, vol. 277, no. 9, pp. 739–745, 1997.
[49]
C. D. Furberg, J. T. Wright, B. R. Davis et al., “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),” Journal of the American Medical Association, vol. 288, no. 23, pp. 2981–2997, 2002.
[50]
F. H. Messerli, H. Makani, A. Benjo, J. Romero, C. Alviar, and S. Bangalore, “Antihypertensive efficacy of hydrochlorothiazide as evaluated by ambulatory blood pressure monitoring: a meta-analysis of randomized trials,” Journal of the American College of Cardiology, vol. 57, no. 5, pp. 590–600, 2011.
[51]
J. McMurray, J. ？stergren, M. Pfeffer et al., “Clinical features and contemporary management of patients with low and preserved ejection fraction heart failure: baseline characteristics of patients in the Candesartan in Heart failure—assessment of Reduction in Mortality and morbidity (CHARM) programme,” European Journal of Heart Failure, vol. 5, no. 3, pp. 261–270, 2003.
[52]
L. H. Lindholm, B. Carlberg, and O. Samuelsson, “Should β blockers remain first choice in the treatment of primary hypertension? A meta-analysis,” Lancet, vol. 366, no. 9496, pp. 1545–1553, 2005.
[53]
B. Pitt, W. Remme, F. Zannad et al., “Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction,” New England Journal of Medicine, vol. 348, no. 14, pp. 1309–1321, 2003.
[54]
H. S. Loeb, G. Johnson, A. Henrick et al., “Effect of enalapril, hydralazine plus isosorbide dinitrate, and prazosin on hospitalization in patients with chronic congestive heart failure,” Circulation, vol. 87, no. 6, supplement 1, pp. VI78–VI87, 1993.
[55]
D. M. McNamara, S. W. Tam, M. L. Sabolinski et al., “Aldosterone synthase promoter polymorphism predicts outcome in African Americans with heart failure. Results from the A-HeFT trial,” Journal of the American College of Cardiology, vol. 48, no. 6, pp. 1277–1282, 2006.
[56]
J. M. Flack, D. A. Sica, G. Bakris et al., “Management of high blood pressure in blacks: an update of the International Society on Hypertension in Blacks consensus statement,” Hypertension, vol. 56, no. 5, pp. 780–800, 2010.
[57]
K. C. Ferdinand and A. M. Armani, “The management of hypertension in African Americans,” Critical Pathways in Cardiology, vol. 6, no. 2, pp. 67–71, 2007.
[58]
J. S. Floras and T. D. Bradley, “Treating obstructive sleep apnea: is there more to the story than 2 millimeters of mercury?” Hypertension, vol. 50, no. 2, pp. 289–291, 2007.
[59]
E. C. Fletcher, “The relationship between systemic hypertension and obstructive sleep apnea: facts and theory,” American Journal of Medicine, vol. 98, no. 2, pp. 118–128, 1995.
[60]
K. Ferrier, A. Campbell, B. Yee et al., “Sleep-disordered breathing occurs frequently in stable outpatients with congestive heart failure,” Chest, vol. 128, no. 4, pp. 2116–2122, 2005.
[61]
S. Redline, P. V. Tishler, M. G. Hans, T. D. Tosteson, K. P. Strohl, and K. Spry, “Racial differences in sleep-disordered breathing in African-Americans and Caucasians,” American Journal of Respiratory and Critical Care Medicine, vol. 155, no. 1, pp. 186–192, 1997.
[62]
T. Young, P. Peppard, M. Palta et al., “Population-based study of sleep-disordered breathing as a risk factor for hypertension,” Archives of Internal Medicine, vol. 157, no. 15, pp. 1746–1752, 1997.
[63]
J. Godoy, P. Mellado, J. Tapia, and J. Santín, “Obstructive Sleep Apnea as an independent stroke risk factor: possible mechanisms,” Current Molecular Medicine, vol. 9, no. 2, pp. 203–209, 2009.
[64]
O. Friedman and A. G. Logan, “The price of obstructive sleep apnea-hypopnea: hypertension and other ill effects,” American Journal of Hypertension, vol. 22, no. 5, pp. 474–483, 2009.
[65]
P. Lavie, P. Herer, and V. Hoffstein, “Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study,” British Medical Journal, vol. 320, no. 7233, pp. 479–482, 2000.
[66]
P. E. Peppard, T. Young, M. Palta, and J. Skatrud, “Prospective study of the association between sleep-disordered breathing and hypertension,” New England Journal of Medicine, vol. 342, no. 19, pp. 1378–1384, 2000.
[67]
E. Shahar, C. W. Whitney, S. Redline et al., “Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the sleep heart health study,” American Journal of Respiratory and Critical Care Medicine, vol. 163, no. 1, pp. 19–25, 2001.
[68]
T. D. Bradley and J. S. Floras, “Obstructive sleep apnoea and its cardiovascular consequences,” The Lancet, vol. 373, no. 9657, pp. 82–93, 2009.
[69]
M. Alchanatis, G. Paradellis, H. Pini, G. Tourkohoriti, and J. Jordanoglou, “Left ventricular function in patients with obstructive sleep apnoea syndrome before and after treatment with nasal continuous positive airway pressure,” Respiration, vol. 67, no. 4, pp. 367–371, 2000.
[70]
J.-P. Laaban, S. Pascal-Sebaoun, E. Bloch, E. Orvo？n-Frija, J.-M. Oppert, and G. Huchon, “Left ventricular systolic dysfunction in patients with obstructive sleep apnea syndrome,” Chest, vol. 122, no. 4, pp. 1133–1138, 2002.
[71]
M. A. Arias, F. García-Río, A. Alonso-Fernández, O. Mediano, I. Martínez, and J. Villamor, “Obstructive sleep apnea syndrome affects left ventricular diastolic function: effects of nasal continuous positive airway pressure in men,” Circulation, vol. 112, no. 3, pp. 375–383, 2005.
[72]
J. Chan, J. Sanderson, W. Chan et al., “Prevalence of sleep-disordered breathing in diastolic heart failure,” Chest, vol. 111, no. 6, pp. 1488–1493, 1997.
[73]
R. Hyer, Obstructive Sleep Apnea Linked to Vulnerable Vessel Plaque on CT. Internal Medicine News, Elsevier, 2011.
[74]
D. R. Mansfield, N. C. Gollogly, D. M. Kaye, M. Richardson, P. Bergin, and M. T. Naughton, “Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure,” American Journal of Respiratory and Critical Care Medicine, vol. 169, no. 3, pp. 361–366, 2004.
[75]
T. L. Giles, T. J. Lasserson, B. J. Smith, J. White, J. Wright, and C. J. Cates, “Continuous positive airways pressure for obstructive sleep apnoea in adults (Review),” Cochrane Database of Systematic Reviews, no. 3, Article ID CD001106, 2006.
[76]
U. J. Magalang, K. Richards, B. McCarthy et al., “Continuous positive airway pressure therapy reduces right ventricular volume in patients with obstructive sleep apnea: a cardiovascular magnetic resonance study,” Journal of Clinical Sleep Medicine, vol. 5, no. 2, pp. 110–114, 2009.
[77]
Y. Kaneko, J. S. Floras, K. Usui et al., “Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea,” New England Journal of Medicine, vol. 348, no. 13, pp. 1233–1241, 2003.
[78]
J. C. T. Pepperell, S. Ramdassingh-Dow, N. Crosthwaite et al., “Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial,” Lancet, vol. 359, no. 9302, pp. 204–210, 2002.
[79]
J. E. Dimsdale, J. S. Loredo, and J. Profant, “Effect of continuous positive airway pressure on blood pressure: a placebo trial,” Hypertension, vol. 35, no. 1 I, pp. 144–147, 2000.
[80]
J. F. Faccenda, T. W. Mackay, N. A. Boon, and N. J. Douglas, “Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea-hypopnea syndrome,” American Journal of Respiratory and Critical Care Medicine, vol. 163, no. 2, pp. 344–348, 2001.
[81]
H. F. Becker, A. Jerrentrup, T. Ploch et al., “Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea,” Circulation, vol. 107, no. 1, pp. 68–73, 2003.
[82]
F. Campos-Rodriguez, A. Grilo-Reina, J. Perez-Ronchel et al., “Effect of continuous positive airway pressure on ambulatory BP in patients with sleep apnea and hypertension: a placebo-controlled trial,” Chest, vol. 129, no. 6, pp. 1459–1467, 2006.
[83]
F. Campos-Rodriguez, J. Perez-Ronchel, A. Grilo-Reina, J. Lima-Alvarez, M. A. Benitez, and C. Almeida-Gonzalez, “Long-term effect of continuous positive airway pressure on BP in patients with hypertension and sleep apnea,” Chest, vol. 132, no. 6, pp. 1847–1852, 2007.
[84]
J. Durán-Cantolla, F. Aizpuru, J. M. Montserrat et al., “Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial,” British Medical Journal, vol. 341, p. c5991, 2010.
[85]
C. J. Egea, F. Aizpuru, J. A. Pinto et al., “Cardiac function after CPAP therapy in patients with chronic heart failure and sleep apnea: a multicenter study,” Sleep Medicine, vol. 9, no. 6, pp. 660–666, 2008.
[86]
D. M. Becker, M. B. Tuggle, and M. F. Prentice, “Building a gateway to promote cardiovascular health research in African-American communities: lessons and findings from the field,” American Journal of the Medical Sciences, vol. 322, no. 5, pp. 288–293, 2001.
[87]
K. F. Adams, J. Lindenfeld, J. M. O. Arnold et al., “Executive summary: HFSA 2006 comprehensive heart failure practice guideline,” Journal of Cardiac Failure, vol. 12, no. 1, pp. 10–38, 2006.
[88]
D. Levy, S. Kenchaiah, M. G. Larson et al., “Long-term trends in the incidence of and survival with heart failure,” Revista Portuguesa de Cardiologia, vol. 21, no. 11, pp. 1377–1378, 2002.
