| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Hypertension. 2003;41:663.)
© 2003 American Heart Association, Inc.
Scientific Contributions |
From the Department of Pharmacology and Toxicology, and the Neuroscience Program, Michigan State University, East Lansing.
Correspondence to Dr Alex F. Chen, Department of Pharmacology and Toxicology, B403 Life Sciences Building, Michigan State University, East Lansing, MI 48824-1317. E-mail chenal{at}msu.edu
| Abstract |
|---|
|
|
|---|
Key Words: vasopressin endothelin superoxide hypertension, low renin
| Introduction |
|---|
|
|
|---|
We have recently shown that arterial endothelin-1 (ET-1) levels are elevated in deoxycorticosterone acetate (DOCA)salt hypertension,10 and that this resulted in increased O2- production7,10 via ETA receptor activation10 in this low-renin hypertension model.11 However, the mechanisms contributing to increased ET-1 are unknown. The peptide hormone 8-arginine-vasopressin (AVP) is able to stimulate preproendothenlin-1 mRNA expression in arteries and cultured endothelial cells.1214 Furthermore, the enhanced endothelin gene expression observed in DOCA-salt rats was absent in vasopressin-deficient Brattleboro rats treated with DOCA-salt,13 suggesting a functional link between vasopressin and ET-1 gene expression.
The biological effects of vasopressin are mediated through 2 AVP receptor subtypes, the V1 and V2 receptors.1517 V1 receptors mediate vasoconstriction, proliferation, and hypertrophy,18,19 whereas V2 receptors are present in renal epithelial cells, where they control free water and urea reabsorption.20,21 Chronic treatment with a vasopressin V1 receptor antagonist lowered blood pressure and attenuated the increase in preproendothenlin-1 gene expression observed in mesenteric arteries of DOCA-salt rats.14,22 It is thus likely that V1 receptors are involved in vasopressin-induced vascular ET-1 upregulation in DOCA-salt hypertension. However, the relationships among vasopressin, ET-1, and vascular O2- production are unknown. In the present study, we tested the hypothesis that vasopressin contributes to ET-1induced vascular superoxide production in DOCA-salt hypertensive rats. Our findings indicate that arterial ET-1 production is stimulated by vasopressin via its V1 receptors, resulting in increased superoxide levels.
| Methods |
|---|
|
|
|---|
Immunohistochemistry and Immunoassay for Arterial Vasopressin
Immunohistochemistry was performed as previously described.7 Briefly, cross sections of the vessel (6 µm thin) were fixed in ice-cold acetone for 10 minutes, and endogenous peroxidase was inhibited with 0.3% (v/v) hydrogen peroxide for 30 minutes. Sections were blocked with 5% horse serum/PBSTween-20 (pH 7.4) for 20 minutes and then incubated with the primary antibody at room temperature for 2 hours diluted in PBSTween-20 containing 2% horse serum. The primary antibody used was rabbit polyclonal antibody for AVP (1:1000, Oncogene, CN Bioscience Inc). Nonimmune rabbit IgG1 was used as a negative control at the same concentration as that of the primary antibody. Sections were then incubated for 30 minutes with biotinylated secondary goat anti-rabbit antibody (Oncogene), diluted at 1:200 in PBSTween-20 containing 2% horse serum. Visualization was performed with an AEC kit (Vector Laboratories). Nuclei were counterstained with Gills hematoxylin. Images were obtained through a digital camera (SPOT, Diagnostic Instruments Inc).
To quantify arterial vasopressin levels, isolated carotid arteries were cleaned and homogenized in lyses buffer (100 mmol/L K2HPO4, 1 mmol/L PMSF, and 0.2% Triton X-100) and subjected to protein assay (Bio-Rad). An equal volume of 1% trifluoroacetic acid (TFA, Sigma) was added to the homogenized samples, which were then centrifuged at 17 000g for 15 minutes at 4°C. C18 Sep-Pak columns (100 mg, Fisher Scientific) were used for sample extraction. After extraction, samples were evaporated for dryness with a centrifugal concentrator under vacuum and were stored at -20°C. The dry samples were reconstituted with assay buffer and measured immediately with a commercial vasopressin immunoassay kit (Assay Designs Inc). Vasopressin concentrations were calculated with Prism 3.02 software (GraphPad).
Luminometric Immunoassay for Arterial ET-1 Levels
The ET-1 levels of carotid arteries were determined as described previously.23 Isolated carotid arteries of sham and DOCA rats were incubated for 24 hours at 37°C with or without a selective V1 vasopressin receptor antagonist (ß-Mercapto-ß, ß-cyclopenta-methylenepropiony1, O-Me-Tyr2, Arg8 vasopressin, ME-AVP, 10-6 mol/L, Sigma), whereas arteries of normal rats were incubated with AVP (10-7 mol/L, Sigma) under the same conditions. After incubation, arteries were frozen in liquid nitrogen, homogenized for 1 minute in 1 mol/L acetic acid containing 1.5x10-5 mol/L pepstatin (Sigma), and immediately boiled for 10 minutes. After being chilled, the vessel homogenates were centrifuged at 20 000g for 30 minutes at 4°C, and the supernatants were stored at -80°C until use. The supernatants were subjected to ET-1 assay using a commercial ET-1 immunoassay kit (R&D Systems). A microplate luminometer (Fluoroskan Ascent FL, Labsystems) was used to measure the intensity of the light emitted. Ascent software 2.4.1 (Labsystems) was used for calculation of ET-1 levels.
Arterial O2- Levels
The isolated carotid arteries of sham or DOCA rats were incubated for 24 hours with or without ME-AVP at 10-6 mol/L, or incubated with a selective ETA receptor antagonist ABT627 (3x10-8 mol/L, Abbott Laboratories) for 1 hour, whereas the arteries of normal rats were incubated with AVP at 0, 10-8, 10-7, or 10-6 mol/L for 4 or 24 hours. Some carotid arteries of normal rats were incubated for 1 hour with ABT627 (3x10-8 mol/L) or ME-AVP (10-6 mol/L) before AVP addition (10-7 mol/L for 24 hours). Vascular O2- was then assayed using both oxidative dihydroethidium (10-6 mol/L, Molecular Probes) fluorescence and lucigenin (5x10-6 mol/L, Sigma) chemiluminescence as previously described.7
Data Analysis
Data were expressed as mean±SEM. Repeated-measures ANOVA was used for comparison of multiple values obtained from the same subject, whereas factorial ANOVA was used for comparing data obtained from 2 independent groups of animals. The Bonferroni procedure was used to control type 1 errors. A value of P<0.05 was considered statistically significant.
| Results |
|---|
|
|
|---|
|
Vasopressin Increases Arterial O2- Levels Via Its V1 Receptors
In carotid arteries of normal rats, vasopressin treatment for 24 hours dose-dependently increased arterial O2- level, and pretreatment of the vessels for 1 hour with ME-AVP, a selective V1 receptor antagonist, blocked vasopressin-induced O2- (Figure 2A). Vasopressin treatment for 4 hours did not increase arterial O2- levels (data not shown). In DOCA-salt rats, the increased arterial O2- levels were significantly reduced after ME-AVP treatment for 24 hours compared with levels for nontreated controls (Figure 2B).
|
Vasopressin Induces O2- Via Increasing Arterial ET-1 Levels
The selective ETA receptor antagonist ABT627 abolished vasopressin-induced increments in arterial O2- in both normal (Figure 2A) and DOCA-salt rats (Figure 2B). On the other hand, vasopressin treatment for 24 hours significantly elevated arterial ET-1 levels in normal rats compared with nontreated controls (Figure 3A). Vasopressin treatment for 4 hours did not increase arterial ET-1 levels significantly (data not shown). There was a marked increase of arterial ET-1 levels in DOCA-salt rats compared with sham rats, and inhibition of V1-vasopressin receptors with ME-AVP significantly reduced the ET-1 levels (Figure 3B). The effects of ABT627 on vasopressin-induced arterial O2- in normal rats and arterial O2- in DOCA-salt rats were further confirmed by oxidative dihydroethidium fluorescent confocal microscopy (Figure 4).
|
|
| Discussion |
|---|
|
|
|---|
Several previous studies have suggested that vasopressin induces ET-1 gene expression and may play an important role in DOCA-salt hypertension.1214,22,24,25. Brain and plasma levels of vasopressin mRNA and the peptide are increased in rats after DOCA-salt treatment,26,27 and V1-vasopressin receptor antagonists reduce blood pressure in DOCA-salt hypertension.22,24 However, there is no report to date on the arterial levels of vasopressin in DOCA-salt hypertension. In the present study, we demonstrate for the first time that arterial tissue vasopressin levels are
3-fold higher in DOCA-salt rats than in sham rats. The source of this increased vasopressin is likely from the circulating blood, consistent with previous published findings.26,27
In our recent studies, we have shown that arterial ET-1 levels are significantly elevated in DOCA-salt hypertensive rats,10 which contribute to the augmented O2- levels.7,10 Because vasopressin has been shown to stimulate preproendothenlin-1 mRNA expression in arteries and cultured endothelial cells,1214 we examined the possible effect of vasopressin on arterial superoxide production. Our data indicate that vasopressin stimulated superoxide production in carotid arteries of normal rats in 24 hours, an effect that was abolished by both the V1 receptor antagonist ME-AVP and the ETA receptor antagonist ABT627. These findings suggest that vasopressin induces O2- production via its V1 receptors, and the effect is ET-1 dependent. Similarly, the elevated arterial superoxide levels in DOCA-salt rats were blunted by both V1 receptor antagonist ME-AVP and ETA receptor antagonist ABT627, suggesting that the increased arterial vasopressin stimulates O2- production via V1 receptors in DOCA-salt hypertension. These findings are consistent with a recent study showing that vasopressin-induced hemodynamic responses in DOCA-salt hypertension are reduced by ETA receptor antagonism.28
The direct effect of vasopressin on arterial ET-1 production was also investigated in the present study. Our results demonstrate that ET-1 levels were significantly increased in carotid arteries treated with vasopressin for 24 hours in vitro. Furthermore, the V1 receptor antagonist ME-AVP significantly reduced ET-1 levels in carotid arteries of DOCA-salt rats and had no effect on the basal arterial ET-1 levels in sham rats. Because arterial vasopressin levels are
3-fold higher in DOCA-salt rats than in sham rats, as shown in the present study, these data together suggest that vasopressin stimulates arterial ET-1 in DOCA-salt rats compared with sham controls. This conclusion is further supported by our findings that after 24-hour incubation, vasopressin significantly increased O2- levels in carotid arteries of normal rats, in addition to augmenting ET-1 levels. Similarly, the V1 receptor antagonist ME-AVP decreased both ET-1 and O2- levels in carotid arteries of DOCA-salt rats after 24-hour incubation. The work of others has shown that elevation in ET-1 expression observed in DOCA-salt rats is attenuated in vasopressin-deficient Brattleboro rats13 or in rats treated chronically with a V1 antagonist.14,22 Therefore, it is likely that high arterial ET-1 levels stimulated by vasopressin contribute to increased arterial O2- levels in this low-renin model of hypertension. Direct functional studies are underway to verify that increased vasopressin stimulates in vivo ET-1 and superoxide production in DOCA-salt rats.
It is of interest to note that an incubation time of 24 hours was required for vasopressin to increase either ET-1 or superoxide levels in the carotid arteries of normal rats, whereas an incubation time of 4 hours failed to produce this effect. The most likely explanation for these experimental observations is that vasopressin-induced arterial superoxide production depends on the newly synthesized ET-1 peptide from preproET-1, a process that requires a period of longer than 4 hours.29,30 Alternatively, the cellular source for new ET-1 synthesis could be smooth muscle cells instead of endothelial cells, because agonists such as cytokines have been shown to stimulate ET-1 release quite rapidly from endothelial cells.31
However, it is important to point out that although we observed that arterial vasopressin levels are
3-fold higher in DOCA-salt rats than in sham rats (7.1±1.4 versus 1.9±04 pg/mg protein), previously published studies showed that the normal plasma vasopressin levels (1 to 30 pmol/L) are generally elevated by 3- to 5-fold in the benign phase of hypertension in this model.32,33 In addition, although ABT627 reversed the effect of vasopressin on vascular O2- levels, vasopressin treatment of carotid arteries of normal rats for 24 hours in vitro only elevated arterial ET-1 levels to a small extent compared with the increase in vasopressin levels observed in the vessels of DOCA-salt rats. Similarly, ME-AVP only reduced arterial ET-1 levels by
40% in DOCA-salt rats after 24-hour incubation. A possible reason for these experimental observations may be that the effects of vasopressin on both ET-1 and superoxide levels observed in carotid arteries of DOCA-salt rats were chronic in nature (several weeks) and at an advanced stage of hypertension (ie, 4 to 6 weeks after DOCA implantation). Nonetheless, our data are consistent with the published findings that vasopressin increases both ET-1 mRNA expression12 and ET-1 release34 in rat mesenteric arteries and that the effects of vasopressin in modulating vascular structure and function are at least in part mediated by enhanced ET-1 expression.1214
Perspectives
In conclusion, the present study demonstrates, for the first time, that vasopressin stimulates arterial ET-1 production via its V1 receptors, resulting in increases superoxide levels in carotid arteries of DOCA-salt hypertensive rats. These findings may provide a novel insight into the humoral mechanisms of low-renin hypertension.
| Acknowledgments |
|---|
Received October 4, 2002; first decision October 25, 2002; accepted November 6, 2002.
| References |
|---|
|
|
|---|
2. Somers MJ, Mavromatis K, Galis ZS, Harrison DG. Vascular superoxide production and vasomotor function in hypertension induced by deoxycorticosterone acetatesalt. Circulation. 2000; 101: 17221728.
3. Nishiyama A, Fukui T, Fujisawa Y, Rahman M, Tian RX, Kimura S, Abe Y. Systemic and regional hemodynamic responses to Tempol in angiotensin IIinfused hypertensive rats. Hypertension. 2001; 37: 7783.
4. Ohara Y, Peterson TE, Harrison DG. Hypercholesterolemia increases endothelial superoxide anion production. J Clin Invest. 1993; 91: 25462551.[Medline] [Order article via Infotrieve]
5. Griendling KK, Minieri GA, Ollerenshaw JD, Alexander AW. Angiotensin II stimulates NADH and NADPH oxidase activity in cultured vascular smooth muscle cells. Circ Res. 1994; 74: 11411148.
6. Pagano PJ, Clark JK, Cifuentes-Pagano ME, Clark SM, Callis GM, Quinn MT. Localization of a constitutively active, phagocyte-like NADPH oxidase in rabbit aortic adventitia: enhancement by angiotensin II. Proc Natl Acad Sci U S A. 1997; 94: 1448314488.
7. Li LX, Crockett E, Wang DH, Galligan JJ, Fink GD, Chen AF. Gene transfer of endothelial NO synthase and manganese superoxide dismutase on arterial vascular cell adhesion molecule-1 expression and superoxide production in deoxycorticosterone acetate-salt hypertension. Arterioscler Thromb Vasc Biol. 2002; 22: 249255.
8. Heinecke JW, Baker L, Rosen H, Chait A. Superoxide-mediated modification of low-density lipoprotein by arterial smooth muscle cells. J Clin Invest. 1986; 77: 757761.[Medline] [Order article via Infotrieve]
9. Griendling KK, Harrison DG. Dual role of reactive oxygen species in vascular growth. Circ Res. 1999; 85: 562563.
10. Li LX, Fink GD, Watts SW, Northcott CA, Galligan JJ, Pagano PJ, Chen AF. ET-1 increases vascular superoxide via ETA-NADPH oxidase pathway in low renin hypertension. Circulation. 2003. In press.
11. Gavras H, Brunner HR, Laragh JH, Vaughan ED Jr, Koss M, Cote LJ, Gavras I. Malignant hypertension resulting from deoxycorticosterone acetate and salt excess: role of renin and sodium in vascular changes. Circ Res. 1975; 36: 300309.
12. Imai T, Hirata Y, Emori T, Yanagisawa M, Masaki T, Marumo F. Induction of endothelin-1 gene by angiotensin and vasopressin in endothelial cells. Hypertension. 1992; 19: 753757.
13. Intengan HD, Park JB, Schiffrin EL. Blood pressure and small arteries in DOCA-salttreated genetically AVP-deficient rats: role of endothelin. Hypertension. 1999; 34: 907913.
14. Intengan HD, He G, Schiffrin EL. Effect of vasopressin antagonism on structure and mechanics of small arteries and vascular expression of endothelin-1 in deoxycorticosterone acetate salt hypertensive rats. Hypertension. 1998; 32: 770777.
15. Birnbaumer M, Seibold A, Gilbert S, Ishido M, Barberis C, Antaramian A, Brabet P, Rosenthal W. Molecular cloning of the receptor for human antidiuretic hormone. Nature. 1992; 357: 333335.[CrossRef][Medline] [Order article via Infotrieve]
16. Thibonnier M, Auzan C, Madhun Z, Wilkins P, Berti-Mattera L, Clauser E. Molecular cloning, sequencing, and functional expression of a cDNA encoding the human V1A vasopressin receptor. J Biol Chem. 1994; 269: 33043310.
17. Jard S, Lombard C, Marie J, Devilliers G. Vasopressin receptors from cultured mesangial cells resemble V1A type. Am J Physiol. 1987; 253: F41F49.[Medline] [Order article via Infotrieve]
18. Tahara A, Tomura Y, Wada K, Kusayama T, Tsukada J, Ishii N, Yatsu T, Uchida W, Tanaka A. Effect of YM087, a potent nonpeptide vasopressin antagonist, on vasopressin-induced hyperplasia and hypertrophy of cultured vascular smooth muscle cells. J Cardiovasc Pharmacol. 1997; 30: 759766.[CrossRef][Medline] [Order article via Infotrieve]
19. Tahara A, Tomura Y, Wada K, Kusayama T, Tsukada J, Ishii N, Yatsu T, Uchida W, Tanaka A. Effect of YM087, a potent nonpeptide vasopressin antagonist, on vasopressin-induced protein synthesis in neonatal rat cardiomyocyte. Cardiovasc Res. 1998; 38: 198205.
20. Butlen D, Guillon G, Rajerison RM, Jard S, Sawyer WH, Manning M. Structural requirements for activation of vasopressin-sensitive adenylate cyclase, hormone binding, and antidiuretic actions: effects of highly potent analogues and competitive inhibitors. Mol Pharmacol. 1978; 14: 10061017.
21. Jans DA, Peters R, Zsigo J, Fahrenholz F. The adenylate cyclase-coupled vasopressin V2 receptor is highly laterally mobile in membranes of LLC-PK1 renal epithelial cells at physiological temperature. EMBO J. 1989; 8: 24812488.[Medline] [Order article via Infotrieve]
22. Burrell LM, Phillips PA, Stephenson JM, Risvanis J, Rolls KA, Johnston CI. Blood pressure-lowering effect of an orally active vasopressin V1 receptor antagonist in mineralocorticoid hypertension in the rat. Hypertension. 1994; 23: 737743.
23. Sakai S, Miyauchi T, Sakurai T, Kasuya Y, Ihara M, Yamaguchi I, Goto K, Sugishita Y. Endogenous endothelin-1 participates in the maintenance of cardiac function in rats with congestive heart failure: marked increase in endothelin-1 production in the failing heart. Circulation. 1996; 93: 12141222.
24. Okada H, Suzuki H, Kanno Y, Saruta T. Effects of novel, nonpeptide vasopressin antagonists on progressive nephrosclerosis in rats. J Cardiovasc Pharmacol. 1995; 25: 847852.[Medline] [Order article via Infotrieve]
25. Yu M, Gopalakrishnan V, McNeill JR. Role of endothelin and vasopressin in DOCA-salt hypertension. Br J Pharmacol. 2001; 132: 447454.
26. Grillo CA, Saravia F, Ferrini M, Piroli G, Roig P, Garcia SI, de Kloet ER, De Nicola AF. Increased expression of magnocellular vasopressin mRNA in rats with deoxycorticosterone-acetateinduced salt appetite. Neuroendocrinology. 1998; 68: 105115.[CrossRef][Medline] [Order article via Infotrieve]
27. Saravia FE, Grillo CA, Ferrini M, Roig P, Lima AE, de Kloet ER, De Nicola AF. Changes of hypothalamic and plasma vasopressin in rats with deoxycorticosterone-acetate induced salt appetite. J Steroid Biochem Mol Biol. 1999; 70: 4757.[CrossRef][Medline] [Order article via Infotrieve]
28. Yu M, Gopalakrishnan V, Wilson TW, McNeill JR. Endothelin antagonist reduces hemodynamic responses to vasopressin in DOCA-salt hypertension. Am J Physiol Heart Circ Physiol. 2001; 281: H2511H2517.
29. Emori T, Hirata Y, Ohta K, Shichiri M, Marumo F. Secretory mechanism of immunoreactive endothelin in cultured bovine endothelial cells. Biochem Biophys Res Commun. 1989; 160: 93100.[CrossRef][Medline] [Order article via Infotrieve]
30. Tasaka K, Kitazumi K. The control of endothelin-1 secretion. Gen Pharmacol. 1994; 25: 10591069.[Medline] [Order article via Infotrieve]
31. Klemm P, Warner TD, Hohlfeld T, Corder R, Vane JR. Endothelin 1 mediates ex vivo coronary vasoconstriction caused by exogenous and endogenous cytokines. Proc Natl Acad Sci U S A. 1995; 28: 26912695.
32. Morton JJ, Garcia del Rio C, Hughes MJ. Effect of acute vasopressin infusion on blood pressure and plasma angiotensin II in normotensive and DOCA-salt hypertensive rats. Clin Sci (Lond). 1982; 62: 143149.[Medline] [Order article via Infotrieve]
33. Igarashi Y, Suzuki H, Itaya Y, Kondo K, Saruta T. Depressor effects of captopril in DOCA-salt hypertensive rats: role of vasopressin. J Hypertens. 1985; 3: 149153.[CrossRef][Medline] [Order article via Infotrieve]
34. Tomobe Y, Yanagisawa M, Fujimori A, Masaki T, Goto K. Arginine-vasopressin increases the release of ET-1 into perfusate of rat mesenteric artery. Biochem Biophys Res Commun. 1993; 191: 654661.[CrossRef][Medline] [Order article via Infotrieve]
This article has been cited by other articles:
![]() |
K. K. Henderson and K. L. Byron Vasopressin-induced vasoconstriction: two concentration-dependent signaling pathways J Appl Physiol, April 1, 2007; 102(4): 1402 - 1409. [Abstract] [Full Text] [PDF] |
||||
![]() |
H. E. Cingolani, M. C. Villa-Abrille, M. Cornelli, A. Nolly, I. L. Ennis, C. Garciarena, A. M. Suburo, V. Torbidoni, M. V. Correa, M. C. Camilionde Hurtado, et al. The Positive Inotropic Effect of Angiotensin II: Role of Endothelin-1 and Reactive Oxygen Species Hypertension, April 1, 2006; 47(4): 727 - 734. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. Vidal, Y. Sun, S. K. Bhattacharya, R. A. Ahokas, I. C. Gerling, and K. T. Weber Calcium paradox of aldosteronism and the role of the parathyroid glands Am J Physiol Heart Circ Physiol, January 1, 2006; 290(1): H286 - H294. [Abstract] [Full Text] [PDF] |
||||
![]() |
D. M. Pollock Endothelin, Angiotensin, and Oxidative Stress in Hypertension Hypertension, April 1, 2005; 45(4): 477 - 480. [Full Text] [PDF] |
||||
![]() |
C. P. del Villar, C. J. G. Alonso, C. A. Feldstein, L. A. Juncos, and J. C. Romero Role of Endothelin in the Pathogenesis of Hypertension Mayo Clin. Proc., January 1, 2005; 80(1): 84 - 96. [Abstract] [PDF] |
||||
![]() |
J.-S. Zheng, X.-Q. Yang, K. J. Lookingland, G. D. Fink, C. Hesslinger, G. Kapatos, I. Kovesdi, and A. F. Chen Gene Transfer of Human Guanosine 5'-Triphosphate Cyclohydrolase I Restores Vascular Tetrahydrobiopterin Level and Endothelial Function in Low Renin Hypertension Circulation, September 9, 2003; 108(10): 1238 - 1245. [Abstract] [Full Text] [PDF] |
||||
![]() |
L. Li, S. W. Watts, A. K. Banes, J. J. Galligan, G. D. Fink, and A. F. Chen NADPH Oxidase-Derived Superoxide Augments Endothelin-1-Induced Venoconstriction in Mineralocorticoid Hypertension Hypertension, September 1, 2003; 42(3): 316 - 321. [Abstract] [Full Text] [PDF] |
||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Hypertension Home | Subscriptions | Archives | Feedback | Authors | Help | AHA Journals Home | Search Copyright © 2003 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited. |