Journal of Hypertension and Management is an international, open access, peer reviewed journal that publishes wide variety of clinical information in all the aspects of arterial blood pressure. The main objective of the journal is to set a forum for publication, education, and exchange of opinions, and to promote research and publications globally. The Journal provides a platform for all clinicians, surgeons and health professionals to contribute their findings and helps raise awareness among community on hypertension and its management. We aim to publish highest quality clinical content via open access platform providing the readers without charge, immediate and unlimited access.

Journal of Hypertension and Management is an open journal which accelerates research updates on Systolic Pressure, Diastolic Pressure, Primary Hypertension, Hypertension Pathophysiology, Hypertension in Pregnancy, Paediatric Hypertension, Hypertensive Crisis, Diagnosis, Prevention, Management, Lifestyle Modifications, Resistant Hypertension, Epidemiology, Genetic History, Hypertension Comorbidities, etc. The journal accepts articles in the form of Original Article, Reviews, Mini Reviews, Short Communications, Case Reports, Perspectives/Opinions, Letters, Short Note and Commentaries. All articles published in the journal are subject to a rigorous peer review process. Authors can publish their experimental and theoretical results in detail to disseminate the updated research findings.

 
Journal Information

Title: Journal of Hypertension and Management

ISSN: 2474-3690

Editor-in-chief: Stefano Omboni

NLM title abbreviation: J Hypertens Manag

ISO abbreviation: J Hypertens Manag

Other titles: JHM

Category: General Medicine

Country of publication: USA

Language: English

DOI: 10.23937/2474-3690

Publication format (s): Electronic and print

Publication policy: Open Access; COPE guide

Peer review: Double blind

Review speed: 3 weeks

Fast-track review: 10 days

Publication type(s): Periodicals

Publisher: ClinMed International Library

Contact email: contact@clinmedjournals.org

 
Articles Search by   Keyword   |   Journal title   |   Author name   |   DOI

 

 Open Access DOI:10.23937/2474-3690/1510036

Nigerian Citrullus Lanatus Fruit and Seed Juice Reduces Cardiovascular Diseases Modifiable Risk Biomarkers in Normal Experimental Rats

Aminu Ibrahim, Hadiza Babaye, Murtala Ya'u, Kamaluddeen Babagana, Salisu Maiwada Abubakar, Jamila Mashi Ahmad and Abba Babandi

Article Type: RESEARCH ARTICLE | First Published: September 12, 2018

Dyslipidemia and imbalance of electrolytes are among the modifiable risk factors for cardiovascular diseases (CVDs) which cause morbidity and mortality in hypertensive patients. Consumption of fruits and their juices has been shown to be beneficial health wise by lowering risk of coronary artery/cardiovascular diseases, stroke and other degenerative diseases. The lowering effects and protective mechanism of these fruits are probably due to numero...
 

 Open Access DOI:10.23937/2474-3690/1510035e

The Iron Brake Dust Age and the Female Advantage

William J Rowe

Article Type: Editorial Article | First Published: August 08, 2018

The iron brake dust age began with the automobile in the 1890's. Until recently, although air pollution was considered a risk factor for hypertension, the studies lacked statistical significance and were considered controversial. However, a Japanese study, also published in the same year, 2016, showed that the key tracers of brake wear particles for example, iron and copper, were at emission levels comparable to traffic-related atmospheric environments....
 

 Open Access DOI:10.23937/2474-3690/1510034

Hypertension: Drug Adherence and Social Factors

Ana Correia de Oliveira and Paulo Santos

Article Type: Commentary | First Published: August 04, 2018

Hypertension is the most prevalent cardiovascular risk factor in the world, increasing significantly with aging. The treatment of arterial hypertension leads to the reduction of the risk of cardiovascular events, such as stroke and heart disease. In the adult population, the prevalence of hypertension is about 30 to 45%, varying between countries. In 2010, more than 1.3 billion adults age ≥ 20-years-old were hypertensive worldwide, representing an estimated global age-standardized prevalence o...
 

 Open Access DOI:10.23937/2474-3690/1510033

Comparison of Sprint Trial Blood Pressure Methodology Versus Common Office Practice

Adeel Pervez and Richard Keirn

Article Type: Research Article | First Published: June 27, 2018

The SPRINT trial was a landmark study and appeared to set new aggressive goals for the treatment of hypertension. It relied upon an average of multiple blood pressure measurements taken with an automated blood pressure cuff with a noted cool-down period beforehand. Our study was designed to see if the values obtained in common office practice differed from the so called "research grade" numbers achieved in the SPRINT trial. To accomplish this, we...
 

 Open Access DOI:10.23937/2474-3690/1510032

Cerebral Hemodynamics Analysis by Doppler Ultrasound in Chronically Hypertensive Pregnant Women

FA do Vale, RAM de Sa, FC da Silva, CA de Oliveira and LGC Velarde

Article Type: Original Article | First Published: June 25, 2018

The reported prevalence of hypertension varies around the world. According to the World Health Organization, the percentage of the population aged 18 years and over with high blood pressure (systolic blood pressure ≥ 140 or diastolic blood pressure ≥ 90) in 2014 was 26.4% in males and 20.4% in females. Chronic hypertension is estimated to be present in 3% to 5% of pregnancies and is being encountered with increasing frequency....
 

 Open Access DOI:10.23937/2474-3690/1510031e

Brake Iron Dust Inhalation, Magnesium Deficiencies and Hypertension

William J Rowe

Article Type: Editorial Article | First Published: June 09, 2018

Armstrong returned with extraordinary diastolic hypertension (160/135) and Irwin, after his Apollo 15 mission, with blood pressure of 275/125 after only 3 minutes of exercise. Having supervised over 5000 symptom-limited maximum, treadmill hospital based stress tests, I have never seen such extraordinary blood pressure levels. I have shown that the invariable magnesium (Mg) deficiencies of space flight and dehydration with angiotensin and catechol...
 

 Open Access DOI:10.23937/2474-3690/1510030

Lifestyle and Hypertension: An Evidence-Based Review

Cosimo Marcello Bruno, Maria Domenica Amaradio, Gabriele Pricoco, Elisa Marino and Francesca Bruno

Article Type: Review Article | First Published: March 01, 2018

Emerging data suggest that lifestyle habits may affect blood pressure values. In this review, authors examine the more relevant clinical and epidemiological studies about the influence that multiple lifestyle factors play on development of hypertension. They conclude that there is clear evidence that lifestyle changes can have a favorable effect on prevention and treatment of hypertension, with emphasis on alcohol and sodium intake, smoking cessation, physical activity level and dietary pattern....
 

 Open Access DOI:10.23937/2474-3690/1510029

Neil Armstrong's Lunar Diastolic Hypertension

William J Rowe

Article Type: Editorial | First Published: October 11, 2017

Neil Armstrong showed a significantly elevated stress test - diastolic Blood Pressure (BP) during a Bicycle (B) stress test on return from his historic lunar mission; use of a B, provided a considerable advantage over a treadmill for BP accuracy with the test, the day after splashdown....
 

 Open Access DOI:10.23937/2474-3690/1510028

Hypertensive Disorder in Zika Virus Infection

Viroj Wiwanitkit

Article Type: Editorial | First Published: October 09, 2017

At present, Zika virus infection is a big public health problem. The infection can be seen worldwide and is still not successfully controlled. The disease can cause acute febrile illness but the important problems are the possible induction of neurological complication and teratogenic effect....
 

 Open Access DOI:10.23937/2474-3690/1510027

Hypertension in Children: A Single Center Experience

Berfin Uysal, Osman Donmez and Fahrettin Uysal

Article Type: Original Article | First Published: August 31, 2017

Hypertension (HTN) in childhood is a serious cause of mortality and morbidity Hypertension during childhood is diagnosed more than past as a consequence of increasing awareness about childhood hypertension, measuring blood pressure by the accurate technique and childhood obesity epidemic....
 

 Open Access DOI:10.23937/2474-3690/1510026

Angiotensin Converting Enzyme Inhibition with Antiradicalar Activity of Thornback Ray Gelatin Hydrolysate: Determination and Separation of Peptide Fractions

Imen Lassoued, Rim Nasri, Jridi Mourad and Moncef Nasri

Article Type: Research Article | First Published: August 07, 2017

Bioactive peptides from collagen and gelatin with antioxidant and antihypertensive properties have become a topic of great interest for health and food preservation industries. Thornback Ray Skin Gelatin Hydrolysate with an hydrolysis degree of 9.23% was prepared by treatment with Alcalase (TRGH-Alcalase)....
 

 Open Access DOI:10.23937/2474-3690/1510025

Whole Exome Analyses to Examine the Impact of Rare Variants on Left Ventricular Traits in African American Participants from the HyperGEN and GENOA Studies

Anh N Do, Wei Zhao, Vinodh Srinivasasainagendra, Stella Aslibekyan, Hemant K Tiwari, Nita Limdi, Sanjiv J Shah, Degui Zhi, Uli Broeckel, C Charles Gu, DC Rao, Karen Schwander, Jennifer A Smith, Sharon LR Kardia, Donna K Arnett and Marguerite R Irvin

Article Type: Research Article | First Published: July 20, 2017

Left Ventricular (LV) hypertrophy, highest in prevalence among African Americans, is an established risk factor heart failure. Several genome wide association studies have identified common variants associated with LV-related quantitative-traits in African Americans. To date, however, the effect of rare variants on these traits has not been extensively studied, especially in minority groups....
 

 Open Access DOI:10.23937/2474-3690/1510024

Preeclampsia: Pathophysiology and the Maternal-Fetal Risk

Gibran Khalil and Afshan Hameed

Article Type: Review Article | First Published: May 25, 2017

Preeclampsia complicates about 5% of all pregnancies worldwide and is one of the leading causes of maternal and fetal morbidity and even mortality. The disorder is specific to pregnancy characterized by new onset of hypertension and end-organ dysfunction including proteinuria after 20 weeks of gestation....
 

 Open Access DOI:10.23937/2474-3690/1510023

Cardiac Fibrosis in Hypertension

Tracey Keteepe-Arachi and Sanjay Sharma

Article Type: Review Article | First Published: February 14, 2017

Myocardial fibrosis is the hallmark of myocardial remodelling found in hypertensive individuals. This process adversely affects the outcomes of such patients and results in diastolic and systolic cardiac dysfunction, electrical dysrhythmia and potentially sudden death. Collagen metabolism has been highlighted as the primary mechanism by which fibrosis is regulated. However, there are many other facets to the pathophysiology of myocardial fibrosis...
 

 Open Access DOI:10.23937/2474-3690/1510022

The Degree of Apoptosis in the Cytotrophoblast Regulates Amyloidosis Fate in the ER Stress of the Syncytiotrophoblast: Morphological Evidence

C Bosco, M Parra-Cordero and E Diaz

Article Type: Original Article | First Published: December 21, 2016

Recently preeclampsia (PE) has been linked throught molecular evidence to endoplasmic reticulum (ER) stress in the placenta. In this organ ER stress is generated due to placental oxidative stress as a consequence of malperfusion secondary to deficient spiral artery remodeling. Immunohistochemistry and ultrastructural analysis were used to study tissue specimens from 14 term placentas: 4 normal, 4 PE, 3 intrauterine growth restriction (IUGR), and ...
 

 Open Access DOI:10.23937/2474-3690/1510021

Effects of Methotrexateonil-6alphar, VCAM-1 and NF Kappa B Expression in a Rat Model of Metabolic Syndrome

Nicolas F Renna, Jesica M Ramirez, Rodrigo D Garcia, Emiliano A Diez and Roberto M Miatello

Article Type: Research Article | First Published: December 17, 2016

Increasing evidence suggests that immune activation and inflammatory mediators may play a role in the development and progression of atherosclerosis. Several studies have shown that patients with some diseases characterized by inflammatory mediator activation, which rheumatoid arthritis (RA), presented accelerate atherosclerosis. RA is a systemic inflammatory disease and the most common cause of death is due to accelerated atherosclerosis, especi...
 

 Open Access DOI:10.23937/2474-3690/1510020

Can Effective Treatment of Resistant and Uncontrolled Hypertension Improve Outcomes from Atrial Fibrillation Ablation?

Eysenck W and Sulke N

Article Type: Review Article | First Published: October 26, 2016

In recent years, there has been great interest in non-pharmacological methods to manage uncontrolled and resistant hypertension. Renal denervation and formation of a central iliac anastomosis are examples. In addition, renal denervation has yielded promising results in the prevention and treatment of AF. We have analysed the potential explanations for this in detail. A central iliac arteriovenous anastomosis, meanwhile, reduces arterial stiffness...
 

 Open Access DOI:10.23937/2474-3690/1510019

Intensive versus Standard Therapy for Hypertension: The Clinical Trials

Neal Shah, Nicolle M Siegart, Joshua De Leon and Allison B Reiss

Article Type: Review Article | First Published: October 19, 2016

Hypertension is the leading risk factor for premature death and disability. It can be controlled through lifestyle changes and use of antihypertensive medication. This review looks at intensive blood pressure reduction trials in non-diabetic, diabetic, and mixed patients' populations. The primary hypothesis for the Systolic Blood Pressure Intervention Trial (SPRINT) is that treating to a systolic blood pressure target of < 120 mmHg (the intensive...
 

 Open Access DOI:10.23937/2474-3690/1510018

Mineralocorticoid Receptor Blockade Lowers Blood Pressure and Improves Endothelial Function in Obese Patients with Metabolic Syndrome

Danielle GA Ezequiel, Frida Liane Plavnik, Monica B Costa, Julio CM Lovisi, Fernando AB Colugnati, Juliana Machado Saraiva and Rogerio B de Paula

Article Type: Original Article | First Published: October 17, 2016

Introduction: Aldosterone has been implicated in the pathophysiology of both metabolic syndrome (MS) and MS-associated arterial hypertension, despite the use of mineralocorticoid receptor antagonists in these scenarios has been little studied. Objectives: To assess the effects of mineralocorticoid blockade on blood pressure as well as metabolic and renal parameters in mild hypertensive subjects with MS compared with an active control group....
 

 Open Access DOI:10.23937/2474-3690/1510017

Advances in Low-Dimensional Mathematical Modeling of the Human Cardiovascular System

S Malatos, A Raptis and M Xenos

Article Type: Review Article | First Published: September 22, 2016

The mathematical modeling of blood flow in the cardiovascular system has long history. Zero-dimensional (0D) and one-dimensional (1D) models contribute actively to the study of the human cardiovascular system. Usually, low-dimensional models consist of a system of time dependent equations that do not involve spatial derivatives, thus reducing the computational complexity compared to multi-dimensional models. Despite that more complex 3D cardiovas...
 

 Open Access DOI:10.23937/2474-3690/1510016

MyHEART: A Non Randomized Feasibility Study of a Young Adult Hypertension Intervention

Heather M Johnson, Jamie N LaMantia, Ryan C Warner, Nancy Pandhi, Christie M Bartels, Maureen A Smith and Diane R Lauver

Article Type: Original Research | First Published: September 12, 2016

In the United States, young adults (18-39 year-olds) have the lowest hypertension control rates (35%) compared to middle-aged (58%) and older (54%) adults. Ambulatory care for hypertension management often focuses on medication with little time for self-management and behavioral counseling. This study was designed to evaluate the feasibility of MyHEART, a telephone-based health coach self-management intervention for young adults....
 

 Open Access DOI:10.23937/2474-3690/1510015

Angiotensin-Converting Enzyme Inhibitor-Induced Cough Prevalence in Refractory Hypertensive Patients

Andre Nascimento Publio Pereira, Roque Aras Junior, Cristiano Ricardo Bastos Macedo, Ricardo Ribeiro do Nascimento Teixeira, Iuri Reseda Magalhaes, Diego Sant'ana Sondre, Bianca de Almeida Nunes and Juliana Queiroz Vasconcelos Muniz

Article Type: Original Article | First Published: August 18, 2016

Refractory Arterial Hypertension (RAH) is characterized by persistently high blood pressure values. Angiotensin Converting Enzyme (ACE) inhibitors in combination with other antihypertensive drugs are effective for RAH and have good clinical tolerance. According to the literature, the adverse effect of cough in patients using ACE inhibitors occurs in 5 to 20% of them. However, in clinical practice, the incidence appears to be higher, making it dif...
 

 Open Access DOI:10.23937/2474-3690/1510014

Analysis of the Phenomenon of Endoleak of Type I A. Influence of the Mechanical Characterization of the Aorta

Altnji HE, Mbodj C, Bou-Said B and Walter-Le Berre H

Article Type: Research Article | First Published: June 08, 2016

Models of the mechanical behaviour of arterial walls are required for mechanical applications in cardiovascular disease treatments, such as Endovascular Aneurysm Repair (EVAR) in particular, to contribute to the ability to predict type IA endoleak. In this work, an explicit finite-element in-house code was used to evaluate the stresses generated by the blood flow in a whole system consisting of the endograft, plaque, and aneurysmal ao...
 

 Open Access DOI:10.23937/2474-3690/1510013

Hypertension and Anesthesia: What's New?

Pascal Colson and Philippe Gaudard

Article Type: Review Article | First Published: May 16, 2016

Hypertension is a very common disease, the first etiology of chronic cardiovascular disease in adult patients who undergo surgery. Improvement in HTA management is undeniable, but some concerns remain for the perioperative period. This article makes a short review of the state of the art regarding the anesthesia management of hypertensive patient during the perioperative period, with a special focus on anesthesia-hypertension interference....
 

 Open Access DOI:10.23937/2474-3690/1510012

Rethinking our Guideline System: Returning to Evidence Based Medicine as it was Originally Intended

Seth J Baum and Casey Peavler

Article Type: Commentary | First Published: April 20, 2016

The scientific literature is burgeoning at an alarming rate, making it impossible for physicians to integrate, let alone read even a miniscule portion of publications. The STM, a global organization whose aim is to disseminate results of high-level research and publications, recently assessed the magnitude of the literature boom. In 2012 they reported that 1.8 to 1.9 million papers were published in 28,100 active scholarly journals. With regulato...
 

 Open Access DOI:10.23937/2474-3690/1510011

Space Flight and Lunar Dust Hypertension

William J. Rowe

Article Type: Editorial | First Published: April 18, 2016

As a member of a North American Fitness Delegation to China in 1988, with an invitation to present a paper in Guangzhou, I chose as a role model Sy Mah, holder of the Guinness Book of Records for having completed 524 marathons. Mah, a professor of physical education at the University of Toledo, was on a sabbatical in Boston and drove all night for his stress test in the morning; it was very abnormal with evidence of severe ischemia. Because of ti...
 

 Open Access DOI:10.23937/2474-3690/1510010

Prevalence of Hypertensive Emergency in Emergency Room of Rajavithi Hospital

Sumitra Piyanuttapull and Jaruboot Angsanakul

Article Type: Research Article | First Published: April 09, 2016

Hypertensive crisis is common among patients visiting emergency room (ER). Majority of these patients can be treated on an outpatient basis (hypertensive urgency). Other patients have acute end-organ damage and higher morbidity and mortality (hypertensive emergency). However, no study on the prevalence of hypertensive emergency in ER in Thailand was found. We aim to evaluate the prevalence and also potential predictors of hypertensive emergency.....
 

 Open Access DOI:10.23937/2474-3690/1510009

Noninvasive Tools Used Nowadays in both, Clinical Practice and Trials in Order to Assess Blood Pressure

Martyna Zaleska, Olga Mozenska, Katarzyna Nikelewska, Magdalena Chrabaszcz, Weronika Rygier, Jan Gieraltowski, Monika Petelczyc and Dariusz A Kosior

Article Type: Short Review | First Published: April 02, 2016

Hypertension affects currently around 1 billion people worldwide and cardiovascular disease remains the most frequent cause of mortality worldwide. Hypertension societies publish cyclically recommendations how to diagnose and manage this illness. Some of them describes tools used to diagnose this disease, others do not. However nowadays many new methods are introduced to assess blood pressure (BP) values. Some of them allow only to obtain central...
 

 Open Access DOI:10.23937/2474-3690/1510008

Is There an Association between Oral Helicobacter pylori and Hypertension, Coronary Artery Disease?

XM Wang and JKC Yee

Article Type: Research Article | First Published: April 02, 2016

Arterial hypertension is a risk factor for atherosclerosis of whose pathogenesis is unknown but had been reported as associated with H. pylori infection. Growing evidence underscores the causative role of endothelial dysfunction with infection. A possible association between H. pylori infection and cardiovascular and autoimmune disorders has been found....
 

 Open Access DOI:10.23937/2474-3690/1510007

Barriers and Facilitators to Referral for Asymptomatic Hypertension in the Emergency Department: A Multidisciplinary Survey of ED Providers in U.S.

Kimberly Souffront, Deborah Chyun, Christine Kovner and Olubenga Ogedegbe

Article Type: Original Research | First Published: March 24, 2016

Despite the magnitude of hypertension (HTN)-associated morbidity and mortality, HTN remains under diagnosed and poorly controlled, making elevated blood pressure (BP) a problem frequently encountered in the emergency department (ED). Nearly 44% of patients in the ED have elevated BP, compared to 27% of those who visit their primary care provider (PCP), and this disproportionately affects ethnic minorities and the elderly....
 

 Open Access DOI:10.23937/2474-3690/1510006

Assessment of Diastolic Behavior of Patients with Hypertension vs. other Myocardial Diseases Using an External Pressure Transducer and Short Handgrip Exercise

Manolas Jan

Article Type: Short Review | First Published: March 23, 2016

Pressocardiogram is a very old noninvasive technique that has been used widely in noninvasive laboratories in and out of hospitals by applying transthoracically an optimal pressure sensor over the maximal LV impulse. It has been proved that this pulse pressure tracing obtained over the maximal LV impulse reflects LVP curve in time and slopes....
 

 Open Access DOI:10.23937/2474-3690/1510005

Treatment of Idiopathic Pulmonary Arterial Hypertension: Current and Clinical Trial Modalities

Raheel Khan, Taimur Abbasi, Roberto F. Machado and Jiwang Chen

Article Type: Review Article | First Published: March 02, 2016

Pulmonary hypertension (PH) is a deadly cardiovascular disease that follows a progressive and symptomatic course. This disease presents in approximately 15 cases per million each year and is categorized into five different groups based on established or presumed etiology. The poorly understood role of BMPR II mutation, early onset and severity of symptoms and increased fatality rate associated with IPAH make treatment a challenge for physicians. ...
 

 Open Access DOI:10.23937/2474-3690/1510004

Usefulness of Morning Home Blood Pressure Measurements in Non-Obese and Obese Japanese Patients with Type 2 Diabetes Mellitus: Results of a 10-Years, Prospective and Longitudinal Study

Kyuzi Kamoi

Article Type: Original Article | First Published: November 05, 2015

It was demonstrated that home blood pressure (HBP) has a stronger predictive power for death, micro- and macrovascular complications than clinic blood pressure (CBP) in patients with type 2 diabetes mellitus (T2DM). This study investigated which of these measurements offers predicatively stronger power for outcomes over 10 years in non-obese and obese patients with T2DM....
 

 Open Access DOI:10.23937/2474-3690/1510003

Disparities in Prevalence, Treatment, and Control of Hypertension among Low Wage Immigrant Workers beyond Health Insurance Coverage: The Las Vegas Hotel Room Cleaners Blood Pressure Study

Krause N and Arias OE

Article Type: Research Article | First Published: September 07, 2015

Objective: To identify disparities in hypertension prevalence, treatment and control among female hotel room cleaners (HRC) compared to the U.S. population that may persist beyond health insurance coverage. Methods: A community-based participatory research project obtained resting blood pressure readings and information on antihypertensive medication from 866 Las Vegas HRCs....
 

 Open Access DOI:10.23937/2474-3690/1510002

Preserved Left Ventricular Performance in Spontaneously Hypertensive Rats Following Preload and Afterload Challenges

Ming Fan, Mahmoud M. El-Mas, and Abdel A. Abdel-Rahman

Article Type: Original Research Article | First Published: August 29, 2015

Chronic LV pressure overload, e.g. in hypertension, leads to cardiac hypertrophy and ultimately heart failure. However, it is not clear if cardiac performance is compromised during early stages of LV hypertrophy before the development of heart failure. Studies in animals with LV hypertrophy revealed conflicting results due to differences in the magnitude, duration, and method of induction of cardiac hypertrophy as well as in the ventricular chamb...
 

 Open Access DOI:10.23937/2474-3690/1510001

Review of 2003 to 2015 Guidelines on Treatment of Hypertension in Patients with Coronary Artery Disease

Wilbert S. Aronow

Article Type: Review Article | First Published: July 18, 2015

Patients with coronary artery disease should have their modifiable coronary risk factors intensively treated. Dietary sodium should be reduced. Hypertension should be treated with beta blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Long-acting nitrates are effective antianginal and antiischemic drugs. Calcium channel blockers may be added if angina persists despite beta blockers and long-acting nitrates......

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