Sex Differences in Blood Pressure Trajectories Over the Life Course
If we assume that women and men exhibit variations of the same fundamental vascular physiology, then conventional analyses of subclinical measures would suggest that women catch up to men by midlife in the extent of potentially important vascular disease. Alternatively, under the assumption that vas...
Saved in:
Published in | JAMA cardiology Vol. 5; no. 3; p. 19 |
---|---|
Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
01.03.2020
|
Subjects | |
Online Access | Get more information |
Cover
Loading…
Abstract | If we assume that women and men exhibit variations of the same fundamental vascular physiology, then conventional analyses of subclinical measures would suggest that women catch up to men by midlife in the extent of potentially important vascular disease. Alternatively, under the assumption that vascular physiology may fundamentally differ between women and men, a sex-specific analysis of existing data could offer new insights and augment our understanding of sex differences in cardiovascular diseases.
To evaluate whether longitudinal patterns of blood pressure (BP) elevation differ between women and men during the life course when considering baseline BP levels as the reference.
We conducted sex-specific analyses of longitudinal BP measures (144 599 observations) collected for a period of 43 years (1971 to 2014) in 4 community-based US cohort studies. The combined total included 32 833 participants (54% female) spanning ages 5 to 98 years. Data were analyzed between May 4, 2019, and August 5, 2019.
Age and serially assessed longitudinal BP measures: systolic BP, diastolic BP, mean arterial pressure (MAP), and pulse pressure (PP).
Sex-specific change in each primary BP measure compared with baseline BP levels, derived from multilevel longitudinal models fitted over the age span, and new-onset cardiovascular disease events.
Of the 32 833 participants, 17 733 were women (54%). Women compared with men exhibited a steeper increase in BP that began as early as in the third decade and continued through the life course (likelihood ratio test χ2 = 531 for systolic BP; χ2 = 123 for diastolic BP; χ2 = 325 for MAP; and χ2 = 572 for PP; P for all <.001). After adjustment for multiple cardiovascular disease risk factors, these between-sex differences in all BP trajectories persisted (likelihood ratio test χ2 = 314 for systolic BP; χ2 = 31 for diastolic BP; χ2 = 129 for MAP; and χ2 = 485 for PP; P for all <.001).
In contrast with the notion that important vascular disease processes in women lag behind men by 10 to 20 years, sex-specific analyses indicate that BP measures actually progress more rapidly in women than in men, beginning early in life. This early-onset sexual dimorphism may set the stage for later-life cardiovascular diseases that tend to present differently, not simply later, in women compared with men. |
---|---|
AbstractList | If we assume that women and men exhibit variations of the same fundamental vascular physiology, then conventional analyses of subclinical measures would suggest that women catch up to men by midlife in the extent of potentially important vascular disease. Alternatively, under the assumption that vascular physiology may fundamentally differ between women and men, a sex-specific analysis of existing data could offer new insights and augment our understanding of sex differences in cardiovascular diseases.
To evaluate whether longitudinal patterns of blood pressure (BP) elevation differ between women and men during the life course when considering baseline BP levels as the reference.
We conducted sex-specific analyses of longitudinal BP measures (144 599 observations) collected for a period of 43 years (1971 to 2014) in 4 community-based US cohort studies. The combined total included 32 833 participants (54% female) spanning ages 5 to 98 years. Data were analyzed between May 4, 2019, and August 5, 2019.
Age and serially assessed longitudinal BP measures: systolic BP, diastolic BP, mean arterial pressure (MAP), and pulse pressure (PP).
Sex-specific change in each primary BP measure compared with baseline BP levels, derived from multilevel longitudinal models fitted over the age span, and new-onset cardiovascular disease events.
Of the 32 833 participants, 17 733 were women (54%). Women compared with men exhibited a steeper increase in BP that began as early as in the third decade and continued through the life course (likelihood ratio test χ2 = 531 for systolic BP; χ2 = 123 for diastolic BP; χ2 = 325 for MAP; and χ2 = 572 for PP; P for all <.001). After adjustment for multiple cardiovascular disease risk factors, these between-sex differences in all BP trajectories persisted (likelihood ratio test χ2 = 314 for systolic BP; χ2 = 31 for diastolic BP; χ2 = 129 for MAP; and χ2 = 485 for PP; P for all <.001).
In contrast with the notion that important vascular disease processes in women lag behind men by 10 to 20 years, sex-specific analyses indicate that BP measures actually progress more rapidly in women than in men, beginning early in life. This early-onset sexual dimorphism may set the stage for later-life cardiovascular diseases that tend to present differently, not simply later, in women compared with men. |
Author | Bairey Merz, C Noel Kim, Andy Ebinger, Joseph E Niiranen, Teemu J Claggett, Brian L Ji, Hongwei Cheng, Susan |
Author_xml | – sequence: 1 givenname: Hongwei surname: Ji fullname: Ji, Hongwei organization: Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China – sequence: 2 givenname: Andy surname: Kim fullname: Kim, Andy organization: Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California – sequence: 3 givenname: Joseph E surname: Ebinger fullname: Ebinger, Joseph E organization: Hypertension Center of Excellence, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California – sequence: 4 givenname: Teemu J surname: Niiranen fullname: Niiranen, Teemu J organization: Turku University Hospital, Department of Medicine, University of Turku, Turku, Finland – sequence: 5 givenname: Brian L surname: Claggett fullname: Claggett, Brian L organization: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts – sequence: 6 givenname: C Noel surname: Bairey Merz fullname: Bairey Merz, C Noel organization: Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California – sequence: 7 givenname: Susan surname: Cheng fullname: Cheng, Susan organization: Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31940010$$D View this record in MEDLINE/PubMed |
BookMark | eNo1j91KxDAUhIMo7rruG4jkBVqT9CRtLrX-QmEF1-sle3KKLdt2SVrRt7egXg3DfAwzF-y0H3pi7EqKVAohb1rXOXTBN0OqhLSpzoQ5YUuVFSIx2soFW8fYihk11kKmztkikxZmL5asfKMvft_UNQXqkSJven53GAbPXwPFOAXi2-BawnEIzRxvPinw8YN41dTEy2EKkS7ZWe0OkdZ_umLvjw_b8jmpNk8v5W2VOA0wJloTKW9QKmkyi4heF95LJGdyQFsXkO-NJ5z3A4CCHLTOsPDoBdQISq3Y9W_vcdp35HfH0HQufO_-36gfQHZOuw |
CitedBy_id | crossref_primary_10_1001_jamanetworkopen_2020_19046 crossref_primary_10_1152_ajpheart_00018_2023 crossref_primary_10_2337_dc23_2275 crossref_primary_10_5897_JPHE2023_1477 crossref_primary_10_1093_ajh_hpad092 crossref_primary_10_1016_j_cjca_2022_05_025 crossref_primary_10_1016_j_atherosclerosis_2023_05_016 crossref_primary_10_1007_s11906_023_01257_1 crossref_primary_10_1093_gerona_glab205 crossref_primary_10_1161_JAHA_121_025406 crossref_primary_10_1016_j_ajpc_2021_100181 crossref_primary_10_1152_japplphysiol_00458_2019 crossref_primary_10_15420_ecr_2021_17 crossref_primary_10_1186_s40001_023_01240_1 crossref_primary_10_2147_VHRM_S450775 crossref_primary_10_3389_fendo_2022_1035890 crossref_primary_10_22159_ajpcr_2023_v16i12_49664 crossref_primary_10_1161_HYPERTENSIONAHA_120_15136 crossref_primary_10_1038_s41390_023_02908_4 crossref_primary_10_1016_j_cpcardiol_2024_102698 crossref_primary_10_1161_CIRCGEN_123_004515 crossref_primary_10_1007_s11306_024_02110_5 crossref_primary_10_3390_nu13072149 crossref_primary_10_1007_s00392_023_02253_w crossref_primary_10_1080_03014460_2021_1998621 crossref_primary_10_1093_eurheartj_ehaa1044 crossref_primary_10_3389_fcvm_2022_952621 crossref_primary_10_1161_JAHA_122_026432 crossref_primary_10_3390_s24061730 crossref_primary_10_1080_01913123_2023_2171168 crossref_primary_10_1161_HYPERTENSIONAHA_122_20139 crossref_primary_10_1161_CIRCRESAHA_121_320702 crossref_primary_10_1016_j_archger_2021_104576 crossref_primary_10_1016_S0140_6736_21_00684_X crossref_primary_10_14341_probl13394 crossref_primary_10_3390_jcm12175676 crossref_primary_10_1016_j_jacc_2020_03_060 crossref_primary_10_1038_s41598_023_50028_0 crossref_primary_10_3390_genes14111980 crossref_primary_10_36011_cpp_2020_2_e8 crossref_primary_10_1080_17512433_2023_2189585 crossref_primary_10_1177_09567976211061107 crossref_primary_10_1186_s12889_022_14555_1 crossref_primary_10_1161_JAHA_121_023492 crossref_primary_10_1016_j_ypmed_2023_107747 crossref_primary_10_1038_s41440_023_01492_8 crossref_primary_10_1007_s11906_022_01183_8 crossref_primary_10_3389_fcvm_2022_1048507 crossref_primary_10_1093_ajh_hpac087 crossref_primary_10_1007_s12264_024_01240_z crossref_primary_10_1016_S1474_4422_24_00122_4 crossref_primary_10_1016_j_pmedr_2020_101219 crossref_primary_10_1093_eurjpc_zwab068 crossref_primary_10_1093_eurjpc_zwad365 crossref_primary_10_3390_jcm13041108 crossref_primary_10_15829_1560_4071_2023_5167 crossref_primary_10_1186_s12905_022_01888_7 crossref_primary_10_1080_08037051_2024_2365705 crossref_primary_10_1016_j_jhep_2024_05_003 crossref_primary_10_1093_eurheartj_ehad472 crossref_primary_10_1126_sciadv_adk1487 crossref_primary_10_1093_eurjpc_zwad028 crossref_primary_10_3390_ijms25052601 crossref_primary_10_1042_CS20201017 crossref_primary_10_1152_physrev_00041_2022 crossref_primary_10_14814_phy2_15269 crossref_primary_10_1161_JAHA_121_021922 crossref_primary_10_56984_8ZG5608H7W crossref_primary_10_1161_JAHA_121_021244 crossref_primary_10_1161_HYPERTENSIONAHA_121_17622 crossref_primary_10_1016_j_cjco_2021_09_013 crossref_primary_10_1161_CIRCRESAHA_121_319424 crossref_primary_10_1111_micc_12818 crossref_primary_10_1161_HYPERTENSIONAHA_121_18394 crossref_primary_10_3390_jcm13113179 crossref_primary_10_1007_s11906_020_01071_z crossref_primary_10_1097_AOG_0000000000004945 crossref_primary_10_1016_j_envpol_2021_118685 crossref_primary_10_56082_annalsarscimed_2022_1_13 crossref_primary_10_1161_HYPERTENSIONAHA_124_21721 crossref_primary_10_5551_jat_63371 crossref_primary_10_1186_s12916_020_01780_x crossref_primary_10_1089_jwh_2021_0471 crossref_primary_10_1016_j_lfs_2023_121494 crossref_primary_10_1161_JAHA_122_027329 crossref_primary_10_1177_2470289720957012 crossref_primary_10_3389_fcvm_2023_1254933 crossref_primary_10_1139_cjpp_2023_0406 crossref_primary_10_1186_s12967_023_04247_8 crossref_primary_10_1161_HYPERTENSIONAHA_120_15208 crossref_primary_10_1016_j_beem_2021_101578 crossref_primary_10_1089_jwh_2021_0599 crossref_primary_10_1016_j_beem_2021_101576 crossref_primary_10_3389_fcvm_2022_1006789 crossref_primary_10_3390_brainsci12121691 crossref_primary_10_3390_jcm12175512 crossref_primary_10_1186_s13293_022_00423_5 crossref_primary_10_1038_s41371_021_00576_7 crossref_primary_10_1093_eurjpc_zwac083 crossref_primary_10_1097_MBP_0000000000000566 crossref_primary_10_1161_ATVBAHA_122_318512 crossref_primary_10_3390_cardiogenetics13010005 crossref_primary_10_1016_j_jacadv_2023_100755 crossref_primary_10_1093_ehjci_jeaa195 crossref_primary_10_1007_s11936_020_00860_8 crossref_primary_10_1038_s41371_022_00789_4 crossref_primary_10_1161_HYPERTENSIONAHA_121_17164 crossref_primary_10_4244_EIJ_D_22_00305 crossref_primary_10_3389_fpubh_2023_1167515 crossref_primary_10_1161_HYPERTENSIONAHA_122_20448 crossref_primary_10_1080_08037051_2023_2179337 crossref_primary_10_1016_j_atherosclerosis_2021_03_016 crossref_primary_10_1161_HYPERTENSIONAHA_122_19693 crossref_primary_10_1109_TUFFC_2021_3113867 crossref_primary_10_3390_jcm13030666 crossref_primary_10_1016_j_ecoenv_2024_116220 crossref_primary_10_1007_s11883_021_00941_4 crossref_primary_10_18632_aging_203275 crossref_primary_10_3389_fphys_2021_746278 crossref_primary_10_1289_EHP8325 crossref_primary_10_1016_j_neubiorev_2023_105145 crossref_primary_10_1007_s12181_024_00694_9 crossref_primary_10_1016_j_pcad_2023_12_001 crossref_primary_10_1016_j_semcdb_2021_01_001 crossref_primary_10_1161_JAHA_120_019764 crossref_primary_10_5334_gh_1159 crossref_primary_10_1186_s13293_020_00306_7 crossref_primary_10_1038_s41746_023_00851_6 crossref_primary_10_1016_S0140_6736_21_00221_X crossref_primary_10_3390_ijms24044127 crossref_primary_10_1161_CIRCULATIONAHA_123_067302 crossref_primary_10_1186_s13195_022_01138_w crossref_primary_10_1080_14017431_2023_2166101 crossref_primary_10_1093_ajh_hpab059 crossref_primary_10_1161_CIR_0000000000001123 crossref_primary_10_1186_s12872_024_03817_y crossref_primary_10_1093_eurheartj_ehab484 crossref_primary_10_1016_j_cjca_2020_03_002 crossref_primary_10_1016_j_jad_2022_09_048 crossref_primary_10_1093_bioadv_vbae026 crossref_primary_10_3389_fcvm_2022_939103 crossref_primary_10_1097_HJH_0000000000003480 crossref_primary_10_1161_CIRCRESAHA_121_319902 crossref_primary_10_1177_09637214241242463 crossref_primary_10_3390_life13051140 crossref_primary_10_1016_j_recesp_2021_10_016 crossref_primary_10_1136_bmjopen_2022_067312 crossref_primary_10_1161_JAHA_123_031107 crossref_primary_10_1016_j_preghy_2024_101127 crossref_primary_10_1093_eurjpc_zwab109 crossref_primary_10_1038_s41371_022_00772_z crossref_primary_10_1093_eurjpc_zwab104 crossref_primary_10_1016_j_jstrokecerebrovasdis_2024_107754 crossref_primary_10_1161_CIRCRESAHA_123_322762 crossref_primary_10_3389_fphys_2022_967478 crossref_primary_10_1161_HYPERTENSIONAHA_122_18459 crossref_primary_10_1016_j_cjco_2020_02_004 crossref_primary_10_1097_HJH_0000000000003256 crossref_primary_10_1152_ajpregu_00228_2022 crossref_primary_10_1016_j_eclinm_2024_102678 crossref_primary_10_1093_eurheartj_ehac470 crossref_primary_10_1161_CIRCULATIONAHA_120_049360 crossref_primary_10_3389_fcvm_2022_874764 crossref_primary_10_1038_s41371_023_00826_w crossref_primary_10_3389_fcvm_2024_1355980 crossref_primary_10_1161_CIRCULATIONAHA_119_044838 crossref_primary_10_1016_j_scitotenv_2024_170735 crossref_primary_10_1016_j_cjca_2021_02_005 crossref_primary_10_1093_ajh_hpab146 crossref_primary_10_1016_j_amjcard_2023_01_033 crossref_primary_10_1161_HYPERTENSIONAHA_120_14653 crossref_primary_10_1093_ije_dyad084 crossref_primary_10_1161_HYPERTENSIONAHA_123_21228 crossref_primary_10_1161_HYPERTENSIONAHA_121_16490 crossref_primary_10_1016_j_bja_2021_10_052 crossref_primary_10_18087_cardio_2023_10_n2561 crossref_primary_10_1111_acel_13995 crossref_primary_10_1055_a_1892_4800 crossref_primary_10_1016_j_echo_2021_01_011 crossref_primary_10_1097_HJH_0000000000003676 crossref_primary_10_2147_IJWH_S364012 crossref_primary_10_1016_j_annepidem_2022_07_012 crossref_primary_10_1161_CIR_0000000000001209 crossref_primary_10_4070_kcj_2021_0347 crossref_primary_10_1002_sim_10029 crossref_primary_10_1161_CIRCRESAHA_121_318054 crossref_primary_10_1161_HYPERTENSIONAHA_123_21573 crossref_primary_10_1007_s11886_023_01923_5 crossref_primary_10_1007_s40292_024_00644_2 crossref_primary_10_3389_fcvm_2022_990748 crossref_primary_10_1016_j_maturitas_2024_107970 crossref_primary_10_18632_aging_205877 crossref_primary_10_1055_a_1220_8297 crossref_primary_10_36660_ijcs_20200418 crossref_primary_10_1111_1471_0528_16498 crossref_primary_10_1136_heartjnl_2022_320876 crossref_primary_10_1093_ajh_hpab009 crossref_primary_10_1111_jhn_13061 crossref_primary_10_1093_cid_ciaa1928 crossref_primary_10_1111_ejn_15979 crossref_primary_10_1161_JAHA_123_030613 crossref_primary_10_1161_CIRCRESAHA_122_320664 crossref_primary_10_1161_HYPERTENSIONAHA_121_18881 crossref_primary_10_1016_j_jadohealth_2021_10_019 crossref_primary_10_1016_j_ijpsycho_2021_08_004 crossref_primary_10_1111_ppe_13048 crossref_primary_10_1161_HYPERTENSIONAHA_121_17796 crossref_primary_10_1038_s41371_023_00838_6 crossref_primary_10_1001_jamanetworkopen_2021_0169 crossref_primary_10_1093_eurjpc_zwab154 crossref_primary_10_1161_CIRCRESAHA_121_319915 crossref_primary_10_1016_j_isci_2024_109097 crossref_primary_10_15829_1728_8800_2023_3696 crossref_primary_10_1093_eurjcn_zvad131 crossref_primary_10_17079_jkgn_2021_23_3_285 crossref_primary_10_1016_j_healthplace_2023_103033 crossref_primary_10_1016_j_hipert_2020_07_003 crossref_primary_10_1097_ACO_0000000000001205 crossref_primary_10_1097_HJH_0000000000002800 crossref_primary_10_1007_s11886_023_01961_z crossref_primary_10_1186_s40168_021_01009_w crossref_primary_10_1161_JAHA_120_018764 crossref_primary_10_1161_JAHA_121_023738 crossref_primary_10_3389_fpubh_2022_1024083 crossref_primary_10_1002_alz_13452 crossref_primary_10_3389_fphys_2023_1287392 crossref_primary_10_3390_cells9030671 crossref_primary_10_1007_s00125_023_05891_x crossref_primary_10_1016_j_cjco_2023_12_006 crossref_primary_10_1177_21501319231220234 crossref_primary_10_3390_ijms241713094 crossref_primary_10_1016_j_hlc_2021_07_006 crossref_primary_10_1016_S2213_8587_22_00076_6 crossref_primary_10_1152_ajpheart_00262_2020 |
ContentType | Journal Article |
DBID | CGR CUY CVF ECM EIF NPM |
DOI | 10.1001/jamacardio.2019.5306 |
DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed |
DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) |
DatabaseTitleList | MEDLINE |
Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: EIF name: MEDLINE url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search sourceTypes: Index Database |
DeliveryMethod | no_fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 2380-6591 |
ExternalDocumentID | 31940010 |
Genre | Research Support, Non-U.S. Gov't Journal Article Research Support, N.I.H., Extramural |
GrantInformation_xml | – fundername: NIA NIH HHS grantid: R03 AG032631 – fundername: NHLBI NIH HHS grantid: U01 HL064914 – fundername: NHLBI NIH HHS grantid: N01HV68163 – fundername: NCATS NIH HHS grantid: UL1 TR001881 – fundername: NCRR NIH HHS grantid: M01 RR000425 – fundername: NHLBI NIH HHS grantid: R01 HL131532 – fundername: NHLBI NIH HHS grantid: R01 HL143227 – fundername: NHLBI NIH HHS grantid: R01 HL134168 – fundername: NHLBI NIH HHS grantid: R01 HL090957 – fundername: NCATS NIH HHS grantid: UL1 TR000124 |
GroupedDBID | 0R~ 53G ABBLC ABJNI ACGFS ADBBV ALMA_UNASSIGNED_HOLDINGS AMJDE ANMPU BCGUY BRYMA C45 CGR CUY CVF EBS ECM EIF H13 NPM OGROG OVD RAJ TEORI |
ID | FETCH-LOGICAL-a544t-55ee2d6c121639cccd58dd1cea674c9f847b6dec5304442474553c8dcd04fc422 |
IngestDate | Sat Nov 02 12:22:39 EDT 2024 |
IsDoiOpenAccess | false |
IsOpenAccess | true |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 3 |
Language | English |
LinkModel | OpenURL |
MergedId | FETCHMERGED-LOGICAL-a544t-55ee2d6c121639cccd58dd1cea674c9f847b6dec5304442474553c8dcd04fc422 |
OpenAccessLink | https://jamanetwork.com/journals/jamacardiology/articlepdf/2758868/jamacardiology_ji_2020_oi_190096_1609877354.33577.pdf |
PMID | 31940010 |
ParticipantIDs | pubmed_primary_31940010 |
PublicationCentury | 2000 |
PublicationDate | 2020-03-01 |
PublicationDateYYYYMMDD | 2020-03-01 |
PublicationDate_xml | – month: 03 year: 2020 text: 2020-03-01 day: 01 |
PublicationDecade | 2020 |
PublicationPlace | United States |
PublicationPlace_xml | – name: United States |
PublicationTitle | JAMA cardiology |
PublicationTitleAlternate | JAMA Cardiol |
PublicationYear | 2020 |
References | 32186678 - JAMA Cardiol. 2020 Mar 1;5(3):364. doi: 10.1001/jamacardio.2020.0173 31940008 - JAMA Cardiol. 2020 Mar 1;5(3):27-28. doi: 10.1001/jamacardio.2019.5576 |
References_xml | |
SSID | ssj0001699432 |
Score | 2.6075199 |
Snippet | If we assume that women and men exhibit variations of the same fundamental vascular physiology, then conventional analyses of subclinical measures would... |
SourceID | pubmed |
SourceType | Index Database |
StartPage | 19 |
SubjectTerms | Adolescent Adult Aged Aged, 80 and over Aging - physiology Blood Pressure - physiology Cardiovascular Diseases - epidemiology Child Child, Preschool Cohort Studies Female Humans Incidence Longitudinal Studies Male Middle Aged Sex Factors Young Adult |
Title | Sex Differences in Blood Pressure Trajectories Over the Life Course |
URI | https://www.ncbi.nlm.nih.gov/pubmed/31940010 |
Volume | 5 |
hasFullText | |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1La9tAEF6SBkIupXm0TdqEPfRWZCxpVo9jalyCSZxDbcgtaHdHRQXLplVJ6a_v7EOW4qSkzUVIWiG0-j6NZmbnwdiHfIgiKzELpAAyULQcBllRYKALGUutBIZgspGvpsnFHCY34mYju6SRA_X70byS56BK5whXkyX7H8iub0onaJ_wpS0hTNt_wvgL_iKZVfqUPRvZ-skEovukv-9oapd_s355Mog_XtMEraJ5WZWuW92P-4FAJIBNqWpd3fO1T1xj62X99Q6rbs1-4eMh19eNpXURdusKXZbDtKron-gk3Axx8dOvRnl3A9mW63irAVqxRP94MjiF67HVylDRo0rck4dOHD4Q0117ADcpE2KXD0Rsiw80PeRWCwsdyQkw1uvToxvFs9uhbbadZqazx9Q7c6wLLslziKN1QqWrRbX5RHtst73LhulhVZDZK_bS2w783BFhn21hfcB2r3x0xCEbER94jw-8qrnlA2_5wPt84IYPnPjADR-448MRm38ez0YXgW-SERQCoAmEQIx0osKINOtcKaVFpnWosEhSUHlJ2odMNCqaCgBEkIIQscq00kMoFUTRa_aiXtb4lvFClmkulUpKGUMe0iGY69IwTEMVK3nM3rjp365cJZTb9sWc_HXkHdvrWPSe7ZT06eEp6XGNPLNo_AFxWkfv |
link.rule.ids | 780 |
linkProvider | National Library of Medicine |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Sex+Differences+in+Blood+Pressure+Trajectories+Over+the+Life+Course&rft.jtitle=JAMA+cardiology&rft.au=Ji%2C+Hongwei&rft.au=Kim%2C+Andy&rft.au=Ebinger%2C+Joseph+E&rft.au=Niiranen%2C+Teemu+J&rft.date=2020-03-01&rft.eissn=2380-6591&rft.volume=5&rft.issue=3&rft.spage=19&rft_id=info:doi/10.1001%2Fjamacardio.2019.5306&rft_id=info%3Apmid%2F31940010&rft_id=info%3Apmid%2F31940010&rft.externalDocID=31940010 |