Any medication can cause side effects, and high blood pressure (HBP) medications are no exception. However, many people do not have side effects from taking hypertension drugs, and often the side effects are mild. Still, it's important to stay informed and work closely with your doctor to manage any side effects you may have. There's no reason to "suffer in silence." Today there are more medication options than ever for managing high blood pressure (hypertension).
There are many popular medical myths about high blood pressure. For example, many physicians believe that high blood pressure is an “inevitable consequence of aging;” that the “only viable treatment option for high blood pressure patients is medication”; that high blood pressure patients must take their medications “for the rest of their lives”; and, worst of all, that high blood pressure medications are “safe and effective.”
Your blood pressure is reported by placing the systolic number over the diastolic number. For example, your blood pressure might be reported as 120/80. To be diagnosed with high blood pressure, only one of these numbers must be outside of the normal range. But, remember that one high reading doesn’t mean there’s a problem. High blood pressure is a condition that can only be diagnosed by your doctor.

Americans eat far too much dietary sodium, up to three times the recommended total amount, which is 1,500 milligrams (mg) daily for individuals with high blood pressure, says Dr. Fisher. It doesn't take much sodium to reach that 1,500-mg daily cap — just 3/4 of a teaspoon of salt. There's half of that amount of sodium in one Egg McMuffin breakfast sandwich. Weed out high-sodium foods by reading labels carefully. "It is very difficult to lower dietary sodium without reading labels, unless you prepare all of your own food," says Dr. Fisher. Beware in particular of what the American Heart Association has dubbed the "salty six," common foods where high amounts of sodium may be lurking:


Most doctors have been taught that once a diagnosis of “high blood pressure” has been made, blood pressure medication is the treatment of choice. As a result, many physicians believe that the current definition of “high” blood pressure is also the same level of blood pressure at which drug treatments are worthwhile. Unfortunately, this is not the case.
Yes, exercise is an excellent way to help lower your blood pressure. Of course, before you start any exercise program, be sure to talk to your doctor. With your doctor’s guidance, exercise can be a healthy way to help get your blood pressure under control. Exercise strengthens your heart and makes it work more efficiently. This means it won’t have to pump as hard, which leads to lower blood pressure.
As mentioned earlier, blood pressure increases with age, beginning from infancy to older adulthood. Since most healthy babies and children are typically not at risk for blood pressure problems, most doctors do not check their blood pressure routinely. But, the normal BP range for all adults, regardless of their age, is considered to be lesser than 120/80.
As the body increases production of an enzyme called angiotensin I-converting enzyme, or “ACE”, blood pressure increases. Pharmaceutical drugs called ACE inhibitors work by blocking the formation of this enzyme, but they have multiple side effects. Garlic contains gamma-glutamylcysteine, a natural ACE inhibitor.  This chemical, in combination with the high allicin content, gives garlic its ability to dilate arteries, thereby lowering blood pressure. I usually take one clove of garlic and remove the skin, chew well and swallow. Yes nobody wants to be around me after. You can also buy in pill form.
A cold glass of milk offers a solid serving of both calcium and vitamin D, nutrients that work as a team to help lower blood pressure by 3 to 10 percent, according to Bauer’s website. Those numbers may not sound impressive, but they could translate to a 15 percent reduction in heart disease risk, she adds. Other research suggests that people with low levels of calcium are at greater risk of high blood pressure. Don’t miss these 18 other natural remedies for high blood pressure.
In this article, we will describe the kinds of drugs that are used for hypertension, and what steps your doctor should take in choosing (from the incredible array of options) your optimal treatment. Finally, we will provide a reasonably complete list of all the drugs currently used in the U.S. (and in most developed countries) for the treatment of hypertension.
James, P.A., Oparil, S., Carter, B.L., Cushman, W.C., Dennison-Himmelfarb, C., Handler, J., & Ortiz, E. (2013, December 18). 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the eighth joint national committee. Journal of the American Medical Association. Retrieved from http://jamanetwork.com/journals/jama/fullarticle/1791497
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 1997-2019, A.D.A.M., Inc. Duplication for commercial use must be authorized in writing by ADAM Health Solutions.
Because of the need for emergency care, it is important to recognize the early signs of malignant hypertension. The first giveaway is blood pressure of 180/120. You might have bleeding in the eyes due to rupture of the small blood vessels. Other malignant hypertension symptoms can include chest pain, dizziness, a headache, numbness in your extremities, and confusion.

You can have high blood pressure, or hypertension, and still feel just fine. That's because high blood pressure often does not cause signs of illness that you can see or feel. But, high blood pressure, sometimes called "the silent killer," is very common in older people and a major health problem. If high blood pressure isn't controlled with lifestyle changes and medicine, it can lead to stroke, heart disease, eye problems, kidney failure, and other health problems. High blood pressure can also cause shortness of breath during light physical activity or exercise.

Don’t deprive yourself of your favorite sweet treats just because you’re trying to lower your blood pressure. Mangoes are a great source of both fiber and beta-carotene, both of which have been deemed effective at lowering blood pressure. In fact, research published in Current Hypertension Reports suggests that adding beta-carotene-rich foods to your diet may be an effective way to lower blood pressure in no time. Not a fan of raw mangoes? Try freezing and blending them for a tasty homemade sorbet that’s perfect for those hot summer days.
A study shows that drinking 2 cups of a mix of three parts beetroot and one part apple juice can make your systolic blood pressure (the top number) go down in just a few hours. Men may see a bigger benefit than women. High systolic pressure can raise your chances of strokes. Cooked beets and beet greens, which pack lots of potassium, are a good alternative.
There are a number of types and classes of drugs available for the management and treatment of high blood pressure (hypertension). Your doctor or other health care professional will prescribe a drug that fits your specific needs based on your medical condition, and any other existing health problems you may have, for example, kidney disease, heart disease, or diabetes. Your doctor also may recommend other therapies and lifestyle changes like getting more exercise, managing stress, and eating a healthy diet.

A blood pressure reading measures both the systolic and diastolic forces, with the systolic pressure listed first. The numbers show your pressure in units of millimeters of mercury (mm Hg)—how high the pressure inside your arteries would be able to raise a column of mercury. For example, a reading of 120/80 mm Hg means a systolic pressure of 120 mm Hg and diastolic pressure of 80 mm Hg.

Imagine a garden hose hooked up to a spigot. When the hose is flexible and there are no kinks in it, you can turn on the water full blast and it will flow easily through the hose. But if there’s a kink in the hose, the water doesn’t flow as well beyond the kink. And the pressure inside the hose builds up behind the kink. Or imagine there is gunk inside the hose blocking the path of the water. Your arteries are a lot like that garden hose.
Diuretics are among the oldest known medications for treating high blood pressure. They work in the tiny tubes (tubules) of the kidneys to promote the removal of salt from the body. Water (fluid) also is removed along with the salt; however, the exact mechanism whereby diuretics lower blood pressure is not clearly known. The leading theory is that they directly cause the muscles surrounding blood vessels to relax. Diuretics may be used alone for high blood pressure. More frequently, however, low doses of diuretics are used in combination with other medications for high blood pressure to enhance the effect of the other medications.
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

Healthcare professionals use a stethoscope and a manual sphygmomanometer to measure your blood pressure. Typically they take the reading above your elbow. The sphygmomanometer has a bladder, cuff, bulb, and a gauge. When the bulb is pumped it inflates the bladder inside the cuff, which is wrapped around your arm. This inflation will stop the blood flow in your arteries. The stethoscope is used to listen for sound of the heartbeat, and no sound indicates that there is no flow. As the pressure is released from the bladder, you will hear the sound of the blood flowing again. That point becomes systolic reading. The diastolic reading is when you hear no sound again, which means that the blood flow is back to normal.
If an underlying medical condition causes hypertension, you’ll need to treat this condition to maintain a healthy blood pressure. For example, people with sleep apnea tend to develop high blood pressure. Treatment of sleep apnea with a CPAP machine can help to lower your high blood pressure due to sleep apnea. Another example is high blood pressure associated with obesity that improves after weight loss.
Start your day with a round of zesty pink grapefruit and see your blood pressure numbers shoot into a healthy range in no time. In addition to being an excellent source of blood pressure-lowering, immune-boosting vitamin C, pink grapefruit is a good source of lycopene, which multiple studies have deemed effective at reducing blood pressure. In fact, a Finnish study published in Neurology reveals that study subjects with the highest concentrations of lycopene in their blood decreased their risk of stroke by 55 percent.
A healthy blood pressure is in the range 90/50 to 120/80. Blood pressure varies throughout the day and your levels of physical exertion and stress cause it to change, too. So blood pressure should be checked under resting conditions. Single measurements aren’t particularly meaningful. A diagnosis of high blood pressure (hypertension) isn’t normally made unless a high reading is measured on three separate occasions – usually over three months.
The causes are most often some combination of clogged “pipes” and excessive salt in the diet. Lifestyle changes, such as appropriate diet and exercise, are among the most effective treatment strategies for high blood pressure. Relaxation, meditation, and otherwise “taking it easy” are not effective solutions, as valuable as such strategies may be for your psychological well-being.

When taking your blood pressure, it’s imperative that the cuff is put on correctly before starting the measurment. Be sure to refer to your device’s manual for specifications and instructions on proper placement. Also, ensure that the cuff is appropriately sized for your arm. Universal cuff sizes work for most, but custom small or large cuffs are available.


Generally the first sign of experiencing high blood pressure, the tension on the brain can cause a severe headache. These headaches can come in the form of just a dull throbbing to a debilitating migraine. The reason behind the headache is linked to the blood vessels in the brain, which swell due to the higher instance of blood in the system. This swelling then places pressure on sensitive areas of the brain causing pain to radiate throughout the head, in the temples and even down through the neck. Pain can be treating by taking ibuprofen or paracetamol, however these should not be taken too frequently.
Are there any alternatives to Flomax? Flomax is a drug that is often used to treat benign prostatic hyperplasia (BPH). It is an alpha-blocker and it affects the hormones adrenaline and noradrenaline. There may be side effects, and other drugs may be used. Home remedies can also help relieve symptoms. Find out more about Flomax and other treatment options. Read now
When added to a healthy diet, almonds can help influence lower blood pressure levels. In fact, almonds are included in the Dietary Approaches to Stop Hypertension — DASH — Diet. In the diet, almonds are included in the “nuts, seeds and legumes” group. The diet recommends eating four to five servings of this food group per week. With regard to almonds, one serving of almonds is just one-third cup. The healthy monounsaturated fat in almonds contributes to lower blood cholesterol levels and reduced arterial inflammation, which ultimately helps lower the pressure inside the arteries.

Exercise stress test: More commonly used for patients with borderline hypertension. This usually involves pedaling a stationary bicycle or walking on a treadmill. The stress test assesses how the body's cardiovascular system responds to increased physical activity. If the patient has hypertension this data is important to know before the exercise test starts. The test monitors the electrical activity of the heart, as well as the patient's blood pressure during exercise. An exercise stress test sometimes reveals problems that are not apparent when the body is resting. Imaging scans of the heart's blood supply might be done at the same time.


Beta blockers are medications that block norepinephrine and epinephrine (adrenaline) from binding to both beta 1 and beta 2 receptors on organs and muscles, including the muscles surrounding blood vessels that cause the blood vessels to narrow and the heart to beat. By blocking the effect of norepinephrine and epinephrine, beta blockers reduce blood pressure by dilating blood vessels and reducing heart rate. They also may constrict air passages because stimulation of beta receptors in the lung cause the muscles that surround the air passages to contract.
7. Visit your chiropractor. A special chiropractic adjustment could significantly lower high blood pressure, a placebo-controlled study suggests. “This procedure has the effect of not one, but two blood–pressure medications given in combination,” study leader George Bakris, MD, told WebMD. Your chiropractor can create an effective protocol that helps normalize blood pressure without medication or other invasive procedures.

Yes, exercise is an excellent way to help lower your blood pressure. Of course, before you start any exercise program, be sure to talk to your doctor. With your doctor’s guidance, exercise can be a healthy way to help get your blood pressure under control. Exercise strengthens your heart and makes it work more efficiently. This means it won’t have to pump as hard, which leads to lower blood pressure.


Angiotensin II is a very potent chemical formed in the blood by ACE from, angiotensin I. When formed, angiotensin II causes the muscles surrounding blood vessels to contract, thus narrowing the vessels and increasing blood pressure. ACE inhibitors are medications that inhibit the activity of ACE which decreases the production of angiotensin II. As a result, these medications cause the blood vessels to enlarge or dilate, and this reduces blood pressure. This lower blood pressure makes it easier for the heart to pump blood and can improve the function of a failing heart. In addition, the progression of kidney disease due to high blood pressure or diabetes is slowed.

A person consistently showing blood pressure higher than 140/90 over several readings is considered to have hypertension. Doctors advise these people to make effective lifestyle changes to help lower their blood pressure, such as maintaining a healthy weight, including exercise in their daily routine, limiting salt and alcohol intake, and quitting smoking. The doctors will also recommend medication for hypertension depending on how much higher the BP is as compared to the normal blood pressure range and any other health problems that the patient faces.
As you age, prevention becomes even more important. Systolic pressure tends to creep up once you’re older than 50, and it’s far more important in predicting the risk of coronary heart disease and other conditions. Certain health conditions, such as diabetes and kidney disease, may also play a role. Talk to your doctor about how you can manage your overall health to help prevent the onset of hypertension.

Blood pressure is measured both when the heart is actually beating (systolic pressure – the first measurement) and between beats (the resting rate, or diastolic pressure – the second measurement). It is given as two figures, eg 120/80. A device called a sphygmomanometer is used. An inflatable cuff is wrapped around your upper arm. When inflated the cuff stops the blood flow in the main blood vessel in your arm. The nurse then watches a gauge in the sphygmomanometer and listens through a stethoscope as the air in the cuff is released. When the first sound of the heartbeat is heard, the systolic pressure is recorded. When the sound disappears, the diastolic pressure is recorded. Sometimes a computerised blood pressure machine is used to take the readings automatically.

Hypertension, the medical term for high blood pressure, is known as "the silent killer." More than 80 million Americans (33%) have high blood pressure, and as many as 16 million of them do not even know they have the condition. If left untreated, high blood pressure greatly increases your risk for heart attack and stroke. Hypertension is projected to increase about 8 percent between 2013 and 2030.


Most doctors do not make a final diagnosis of high blood pressure until they measure your blood pressure several times (at least 2 blood pressure readings on 3 different days). Some doctors ask their patients to wear a portable machine that measures their blood pressure over the course of several days. This machine may help the doctor find out whether a patient has true high blood pressure or what is known as “white-coat hypertension.” White-coat hypertension is a condition in which a patient’s blood pressure rises during a visit to a doctor when anxiety and stress probably play a role.
Various organizations including the United States Department of Agriculture recommend that Americans consume less than 2,300 milligrams (mg) of sodium per day. But the ideal limit is really no more than 1,500 mg per day for most adults. Unfortunately, the average sodium intake of Americans is more than 3,400 mg per day, according to the Centers for Disease Control and Prevention (CDC). This is partly because sodium is so easy to consume — just 1 teaspoon of salt contains 2,300 mg of sodium.
Your doctor may also use a device called an ophthalmoscope to look at the blood vessels in your eyes. Doctors can see if these vessels have thickened, narrowed, or burst, which may be a sign of high blood pressure. Your doctor will also use a stethoscope to listen to your heart and the sound of blood flowing through your arteries. In some cases, a chest x-ray and electrocardiogram may be needed.

Add olive oil to your blood pressure shopping list. The main reason for this benefit is because of polyphenols. These compounds are known for fighting inflammation and reducing blood pressure, according to UCDavis. That’s why olive oil is a key part of the DASH diet and one of the foods that lower blood pressure. Next, check out the 11 things you need to know about the DASH diet. 


5. Take apple cider vinegar. In addition to lowering blood pressure almost overnight, apple cider vinegar has a myriad of fringe benefits. Apple cider vinegar helps with indigestion, especially if you suffer from diarrhea. It also soothes sore throats, cures hiccups instantly, and lowers cholesterol. Most importantly, it helps with weight loss by improving metabolism and reducing water retention -- and a healthy weight is key to normalizing blood pressure.
The sweet serves up flavanols that help lower blood pressure by relaxing blood vessels and boosting blood flow. On average, regular dark chocolate consumption could help lower your systolic blood pressure (the top number) by 5 points and your diastolic blood pressure (the bottom number) by almost 3 points, suggests an Australian analysis. How dark are we talking? Experts haven't been able to determine an ideal percentage of cocoa, says Vivian Mo, MD, Clinical Associate Professor of Medicine at the Keck School of Medicine of the University of Southern California. But the higher you go, the more benefits you'll get.
4. Cut down on processed food. Just about all processed foods contain huge amounts of fructose, particularly fruit drinks or any fruit-flavored products. Fructose is hidden all over the supermarket, even in the most unlikely places: processed meats, breads, pasta sauces and dressings. Fast food chains love fructose. The only thing they love more is vegetable oil.

As you get older, high blood pressure, especially isolated systolic hypertension, is more common and can increase your risk of serious health problems. Treatment, especially if you have other medical conditions, requires ongoing evaluation and discussions with your doctor to strike the best balance of reducing risks and maintaining a good quality of life.


Last year, new guidelines from the American Heart Association, the American College of Cardiology, and nine other health organizations lowered the numbers for the diagnosis of hypertension (high blood pressure) to 130/80 millimeters of mercury (mm Hg) and higher for all adults. The previous guidelines set the threshold at 140/90 mm Hg for people younger than age 65 and 150/80 mm Hg for those ages 65 and older.

Sodium (salt) sensitivity: Some people have high sensitivity to sodium (salt), and their blood pressure increases if they use salt. Reducing sodium intake tends to lower their blood pressure. Americans consume 10-15 times more sodium than they need. Fast foods and processed foods contain particularly high amounts of sodium. Many over-the-counter medicines also contain large amounts of sodium. Read food labels and learn about salt content in foods and other products as a healthy first step to reducing salt intake. Fast food restaurants also make the salt and calorie content of their food available to consumers at their restaurants,


Typically, more attention is given to systolic blood pressure (the first number) as a major risk factor for cardiovascular disease for people over 50. In most people, systolic blood pressure rises steadily with age due to the increasing stiffness of large arteries, long-term buildup of plaque and an increased incidence of cardiac and vascular disease.
Arthritis is not a specific disease, but a group of disorders affecting the joints, and it is characterized by inflammation, swelling, stiffness, and decreased mobility. These arthritis symptoms come and go, but will progress and worsen with time. Arthritis is more common among seniors and is the leading cause of disability in the geriatric population.
Your blood pressure is reported by placing the systolic number over the diastolic number. For example, your blood pressure might be reported as 120/80. To be diagnosed with high blood pressure, only one of these numbers must be outside of the normal range. But, remember that one high reading doesn’t mean there’s a problem. High blood pressure is a condition that can only be diagnosed by your doctor.
Peter, I’ve been using a blood pressure meter for nearly 30 years, so my response is based on my personal experience and information I’ve acquired over the years. First, I suggest that you take your meter to the doctor and have them check several readings of your meter against theirs. For example, If your meter consistently shows it’s 10 points lower than the doctor’s, just delete the 10 points from your meter reading (have them check both numbers so you can adjust both as necessary). Also, it’s common that many doctor’s offices take your blood pressure incorrectly (you should actually sit still for 5 minutes, with your feet on the floor and the cuff at the same level as your heart) . Some of us have”white coat” hypertension, so you may always be elevated at the doctor’s office. If you are a large man, you (and your doctor’s office) may need to use a larger cuff as the wrong size of cuff can affect your reading. Also, I spoke with customer service at one of the companies that makes many of the home & professional meters, and she told me that the automated machines are not very accurate if you have kidney disease or heart failure (I have both). Ask the doctor’s staff to always use the manual system and it will be more accurate than those noisy automatic ones.
The right tunes can help bring your blood pressure down, according to Italian research. Researchers asked 29 adults who were already taking BP medication to listen to soothing classical, Celtic, or Indian music for 30 minutes daily while breathing slowly. When they followed up with the subjects six months later, their blood pressure had dropped by an average of 4 mmHg.
Jamerson KA, Bakris GL, Wun CC, et al. Rationale and Design of the Avoiding Cardiovascular Events Through Combination Therapy in Patients Living With Systolic Hypertension (ACCOMPLISH) Trial: the First Randomized Controlled Trial to Compare the Clinical Outcome Effects of First-line Combination Therapies in Hypertension. Am J Hypertens 2004; 17:793.
The new guidelines stem from the 2017 results of the Systolic Blood Pressure Intervention Trial (SPRINT), which studied more than 9,000 adults ages 50 and older who had systolic blood pressure (the top number in a reading) of 130 mm Hg or higher and at least one risk factor for cardiovascular disease. The study's aim was to find out whether treating blood pressure to lower the systolic number to 120 mm Hg or less was superior to the standard target of 140 mm Hg or less. The results found that targeting a systolic pressure of no more than 120 mm Hg reduced the chance of heart attacks, heart failure, or stroke over a three-year period.
Hypertension Stage 1 is when blood pressure consistently ranges from 130-139 systolic or 80-89 mm Hg diastolic. At this stage of high blood pressure, doctors are likely to prescribe lifestyle changes and may consider adding blood pressure medication based on your risk of atherosclerotic cardiovascular disease (ASCVD), such as heart attack or stroke.
Why stress happens and how to manage it Stress is essential for survival; the chemicals it triggers help the body prepare to face danger and cope with difficulty. Long-term stress is linked to various health conditions and can cause physical and psychological symptoms. How is it diagnosed, what types of stress are there, and how is it treated or managed? Read now
7. Visit your chiropractor. A special chiropractic adjustment could significantly lower high blood pressure, a placebo-controlled study suggests. “This procedure has the effect of not one, but two blood–pressure medications given in combination,” study leader George Bakris, MD, told WebMD. Your chiropractor can create an effective protocol that helps normalize blood pressure without medication or other invasive procedures. 

When discussing blood pressure issues, the healthcare professional may ask questions about past medical history, family history, and medication use, including prescriptions, over-the-counter medications, herbal remedies, and food additives. Other questions may include lifestyle habits, including activity levels, smoking, alcohol consumption, and illegal drug use.
Before measuring your blood pressure, do not smoke, drink caffeinated beverages, or exercise for at least 30 minutes before the test. Rest for at least five minutes before the measurements and sit still with your back straight and supported. Feet should be flat on the floor and not crossed. Your arm should also be supported on a flat surface like a table with the upper arm at heart level.

6. Cultivate stress management. You don’t need a meta-analysis of cohort studies to prove stress can raise blood pressure, but they exist. You can’t eliminate stress, but you can minimize its impact. Research shows yoga and meditation create effective strategies to manage stress and blood pressure. If those aren’t your thing, consider other stress-relieving tactics including deep breathing or practicing mindfulness.

Don’t deprive yourself of dessert just because you’re eager to get your blood pressure under control. A little dark chocolate can go a long way when it comes to lowering those numbers, thanks to its flavonoid content. Flavonoids, a type of plant-based pigment, have been linked to reductions in blood pressure, thanks to their ability to improve endothelial function, according to researchers at the University of Manitoba. Just make sure you’re choosing real dark chocolate for the biggest benefit; foods high in sugar, like most milk chocolate bars, have been linked to an increase in blood pressure by researchers at the New Zealand University of Otago. Reduce your risk of chronic disease even further by discovering and ditching the worst habits for heart health ASAP.


Understanding the normal BP range with age can help the doctor and you to estimate your cardiovascular health. Blood pressure levels can fluctuate significantly from one reading to the next and it is important to remember that just one abnormally high reading does not signify that you have high blood pressure. Doctors usually use an average of multiple blood pressure readings taken over a period of several days to arrive at a diagnosis of high blood pressure.
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):e127-e248. PMID: 29146535 www.ncbi.nlm.nih.gov/pubmed/29146535.
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