scholarly journals Hypertension Control and Cardiometabolic Risk: A Regional Perspective

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Martin Thoenes ◽  
Peter Bramlage ◽  
Sam Zhong ◽  
Shuhua Shang ◽  
Massimo Volpe ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Cardiometabolic Risk ◽  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Cross Sectional ◽  
Uncontrolled Blood Pressure ◽  
Regional Perspective

Background. We investigated the association between blood pressure control and common cardiometabolic risk factors from a global and regional perspective.Methods. In the present analysis of a large cross-sectional i-SEARCH study, 17.092 outpatients receiving antihypertensive treatment were included in 26 countries. According to clinical guidelines for the management of arterial hypertension, patients were classified based on the level of seated systolic/diastolic blood pressure (SBP/DBP). Uncontrolled hypertension was defined as SBP/DBP ≥140/90 mmHg for non-diabetics, and ≥130/80 mmHg for diabetics.Results. Overall, mean age was 63.1 years, 52.8% were male, and mean BMI was 28.9 kg/m2. Mean SBP/DBP was 148.9/87.0 mmHg, and 76.3% of patients had uncontrolled hypertension. Diabetes was present in 29.1% with mean HbA1c of 6.8%. Mean LDL-cholesterol was 3.2 mmol/L, HDL-cholesterol 1.3 mmol/L, and triglycerides 1.8 mmol/L; 49.0% had hyperlipidemia. Patients with uncontrolled hypertension had a higher BMI (29.4 versus 28.6 kg/m2), LDL-cholesterol (3.4 versus 3.0 mmol/L), triglycerides (1.9 versus 1.7 mmol/L), and HbA1c (6.8 versus 6.7%) than those with controlled blood pressure (P<0.0001for all parameters).Conclusions. Among outpatients treated for arterial hypertension, three quarters had uncontrolled blood pressure. Elevated SBP/DBP and uncontrolled hypertension were associated with increasing BMI, LDL-cholesterol, triglycerides, and HbA1c, both globally and regionally.

scholarly journals Impact of valve morphology, hypertension and age on aortic wall properties in patients with coarctation: a two-centre cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e034853
Author(s):  
Niky Ghorbani ◽  
Vivek Muthurangu ◽  
Abbas Khushnood ◽  
Leonid Goubergrits ◽  
Sarah Nordmeyer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Aortic Coarctation ◽  
Cross Sectional Study ◽  
Ascending Aorta ◽  
Uncontrolled Hypertension ◽  
Specific Reference ◽  
Sectional Study ◽  
Cross Sectional ◽  
Descending Aorta

ObjectiveWe aimed to investigate the combined effects of arterial hypertension, bicuspid aortic valve disease (BAVD) and age on the distensibility of the ascending and descending aortas in patients with aortic coarctation.DesignCross-sectional study.SettingThe study was conducted at two university medical centres, located in Berlin and London.ParticipantsA total of 121 patients with aortic coarctation (ages 1–71 years) underwent cardiac MRI, echocardiography and blood pressure measurements.Outcome measuresCross-sectional diameters of the ascending and descending aortas were assessed to compute aortic area distensibility. Findings were compared with age-specific reference values. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology statement and reporting guidelines.ResultsImpaired distensibility (below fifth percentile) was seen in 37% of all patients with coarctation in the ascending aorta and in 43% in the descending aorta. BAVD (43%) and arterial hypertension (72%) were present across all ages. In patients >10 years distensibility impairment of the ascending aorta was predominantly associated with BAVD (OR 3.1, 95% CI 1.33 to 7.22, p=0.009). Distensibility impairment of the descending aorta was predominantly associated with arterial hypertension (OR 2.8, 95% CI 1.08 to 7.2, p=0.033) and was most pronounced in patients with uncontrolled hypertension despite antihypertensive treatment.ConclusionFrom early adolescence on, both arterial hypertension and BAVD have a major impact on aortic distensibility. Their specific effects differ in strength and localisation (descending vs ascending aorta). Moreover, adequate blood pressure control is associated with improved distensibility. These findings could contribute to the understanding of cardiovascular complications and the management of patients with aortic coarctation.

scholarly journals Blood Pressure Control and Associations with Social Support among Hypertensive Outpatients in a Developing Country

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Luu Quang Thuy ◽  
Nguyen Hoang Thanh ◽  
Le Hong Trung ◽  
Pham Huy Tan ◽  
Hoang Thi Phuong Nam ◽  
...  
Keyword(s):  
Social Support ◽  
Blood Pressure ◽  
Blood Pressure Control ◽  
Structural Characteristics ◽  
Pressure Control ◽  
Information Support ◽  
Uncontrolled Hypertension ◽  
Cross Sectional ◽  
Adherence Score ◽  
Practical Support

Relationships between social support characteristics with blood pressure control and recommended behaviors in Vietnamese hypertensive patients have not been investigated. This study is aimed at examining the role of social support characteristics in hypertension control and behaviors. Patients with hypertension ( n = 220 ) in Hanoi, Vietnam, were recruited into a cross-sectional study. Both functional and structural characteristics of social support and network were examined. Results showed that increasing total network size was related to 52% higher odds of uncontrolled hypertension ( adjusted   OR = 1.52 , 95 % CI = 1.22 − 1.89 ). Higher network sizes on the provision of information support related to advice, emotional support related to decisions, and practical support related to sickness were associated with lower odds of uncontrolled hypertension. Every additional 1% of the percentage of network members having hypertension decreased 2% the odds of uncontrolled hypertension ( adjusted   OR = 0.98 , 95 % CI = 0.96 − 1.00 ). A 1% additional network members who were living in the same household was associated with a decrease of 0.08 point of behavioral adherence score ( coef . = − 0.08 ; 95 % CI = − 0.12 − 0.03 ). Meanwhile, a 1% increase of network members who were friends on the provision of practical support related to sickness and jobs was related to an increase of 0.10 point and 0.19 point of behavioral adherence score ( coef . = 0.10 ; 95 % CI = 0.04 − 0.17 and coef . = 0.19 ; 95 % CI = 0.06 − 0.32 , respectively). The current study suggested that further interventions to improve hypertension management should address the potential effects of social network characteristics.

Prevalence, Characteristics and Predictive Factors of Microalbuminuria in Resistant Systemic Arterial Hypertension

2018 ◽  
Vol 69 (9) ◽  
pp. 2425-2429
Author(s):  
Carmen Gadau ◽  
Elena Ardeleanu ◽  
Roxana Folescu ◽  
Ioan Tilea ◽  
Andreea Varga ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Predictive Factors ◽  
Hdl Cholesterol ◽  
Arterial Disease ◽  
Left Ventricular ◽  
Cross Sectional ◽  
Systemic Arterial Hypertension ◽  
Peripheral Arterial ◽  
Made In

The present cross-sectional observational study was made in family medicine offices of Timi� County, Romania. The aim of the study was to investigate the prevalence of urinary microalbumin excretion (MAU) in resistant systemic arterial hypertension (RH), to analyze patients� biochemical and clinical characteristics, and the predictive factors for MAU. From a total number of 347 patients, MAU was detected in 76 cases (21.9%). The microalbuminuria positive patients were older, with significant higher office systolic blood pressure (BP) (155 � 13.50 vs 148 � 12.40 mmHg, p [ 0.0001) and diastolic blood pressure (94 � 12.20 vs 88 � 14.6 mmHg, p = 0.0013), higher prevalence of left ventricular hypertrophy, diabetes mellitus, obesity, ischemic and peripheral arterial disease. MAU positive patients presented statistical significant differences in biochemical data concerning: fasting plasma glucose (FPG) (118.80 � 32.02 vs 108.01 � 26.01 mg/dL, p = 0.003), impaired glucose tolerance (IGT) (10.52 % vs 4.94 %), glycated hemoglobin (HbA1c) (6.56 � 0.98% vs 5.96 � 0.91%, p [ 0.001), reduced estimated glomerular filtration rate (eGFR) (56.10 � 15.4 vs 69.30 � 17.5 ml/min/1.73m2, p [ 0.001) and higher potassium levels (4.71 � 0.43 vs 4.59 � 0.44 mg/dL, p = 0.0378). No significant differences were noticed regarding LDL- and HDL-cholesterol, triglycerides, uric acid and serum creatinine. In a logistic multivariate analysis independent predictors for MAU were: systolic BP (odds ratio, OR = 1.024, 95% confidence interval, CI:1.011-1.039, p [ 0.001), HbA1c (OR = 1.324, 95% CI: 1.078-1.724, p = 0.008) and eGFR (OR = 0.989, 95% CI: 0.977-0.999, p = 0.01). Our findings suggest that an important part of RH patients have microalbuminuria and highlight the importance of controlling its predictors, in order to improve patients� outcome.

scholarly journals Work stress related lipid disorders and arterial hypertension in professional drivers: A cross-sectional study

2013 ◽  
Vol 70 (6) ◽  
pp. 561-568 ◽  
Author(s):  
Natasa Djindjic ◽  
Jovica Jovanovic ◽  
Boris Djindjic ◽  
Milan Jovanovic ◽  
Milica Pesic ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Bus Drivers ◽  
Cross Sectional ◽  
Taxi Drivers ◽  
Professional Drivers ◽  
Lipid Disorders

Background/Aim. Occupational stress is a term used to define ongoing stress that is related to the workplace. The study was conducted to determine association of occupational stress index (OSI) and its aspects with arterial hypertension and lipid disorders using data from a cross-sectional survey of male professional drivers. Methods. The cross-sectional study was performed in 439 professional drivers divided into groups (city- and intercity bus drivers, truck and taxi drivers). The OSI and OSI aspects (high demands, strictness, underload, extrinsic time pressure, noxious exposure, avoidance and conflict) were calculated using the standardized questionnaire. Determination of serum lipids, blood pressure (BP) and cardiovascular risk factors were done. Results. A significant difference in prevalence of diagnosed hypertension and dyslipidemia was found along with a difference in total OSI and OSI aspects among examined subgroups of drivers. A total OSI was highest in city, high in intercity bus drivers, and the lowest one in truck and taxi drivers (82.79 ? 3.5, 81.28 ? 3.7, 73.75 ? 3.5, 71.61 ? 4.4, respectively; p < 0.01). Similar pattern showed triglycerides (TG), total cholesterol (TC) and LDL cholesterol and BP, while HDL-cholesterol showed reverse order (p < 0.01). Logistic regression analyses with multiple OSI aspects adjusted for age and years of exposure showed associations of total OSI with arterial hypertension [OR 5.5; 95% CI (2.24-7.95)] and dyslipidemia [OR 1.43 95% CI (1.09-2.80)]. Underload was the most important OSI aspect associated with the arterial hypertension [OR 1.18; 95% CI (1.04-2.58)] and elevated LDL cholesterol [1.26; 95 CI (1.19-2.1)]. A total OSI had a significant association with elevated LDL cholesterol [2.64; 95% CI (1.19- 7.7)], triglycerides [OR 3.27; 95% CI (1.20-5.1)] and low HDL cholesterol [OR 3.29; 95% CI (1.8-5.8)] (p < 0.01). Conclusion. The study provides the evidence for the significant association of total OSI and underload with lipid disorders and elevated blood pressure in professional drivers, which could be a possible link between job stress and coronary heart disease. Regular periodical examinations and workplace interventions aimed to decrease total OSI and underload are important aspects in primary prevention and additional reduction of cardiovascular risk.

scholarly journals HUBUNGAN PENGETAHUAN TENTANG HIPERTENSI DENGAN PENGENDALIAN TEKANAN DARAH PADA PASIEN HIPERTENSI DI POLIKLINIK PENYAKIT DALAM RSUD DR.MOEWARDI SURAKARTA

Biomedika ◽  
2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Jayanti Wulansari ◽  
Burhannudin Ichsan ◽  
Devi Usdiana
Keyword(s):  
Blood Pressure ◽  
Sampling Technique ◽  
Uncontrolled Hypertension ◽  
Survey Method ◽  
Chi Square ◽  
Cross Sectional ◽  
Uncontrolled Blood Pressure ◽  
Hypertension Patient ◽  
Chi Square Test ◽  
Hypertension Knowledge

Nowadays, hypertension becomes the main problem in the world. Uncontrolled hypertension remains the main health problem. One of the problems that cause uncontrolled blood pressure is the less knowledge of hypertension. Patient’s knowledge and awareness in hypertension is the important factor to control the blood pressure. The aim of this study is to know the relation between hypertension knowledge and blood pressure restraint to hypertension patient in the Internist Polyclinic RSUD dr.Moewardi Surakarta. This research used analytic survey method in cross sectional approach. It took 57 sample of hypertension patient. It used purposive sampling technique. This research used Chi Square statistic test. In forty two patients (73,7%) with well-knowledge, 31 patients hypertension (73,8%) have controlled-blood pressure and uncontrolled blood pressure is 11 patients (26,2%). Whereas, in 15 patients (26,3%) who has lack-knowledge found controlled-blood pressure in 6 patients (40%), and uncontrolled blood pressure in 9 patients (60%). There was not found less-knowledge patients. The Chi Square test found signifi cance probability (p)= 0,019. There is relation between hypertension knowledge and controlling blood pressure.Keywords: knowledge, hypertension, controlling blood pressure

scholarly journals Pharmacogenomics of hypertension in chronic kidney disease: the CKD-PGX study

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0005362021
Author(s):  
Michael T. Eadon ◽  
Judith Maddatu ◽  
Sharon M. Moe ◽  
Arjun D. Sinha ◽  
Ricardo Melo Ferreira ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Antihypertensive Agents ◽  
Pressure Control ◽  
Safety Net ◽  
Uncontrolled Hypertension ◽  
Cross Sectional ◽  
Significant Difference ◽  
Safety Net Hospital

Background: Patients with chronic kidney disease (CKD) often have uncontrolled hypertension despite polypharmacy. Pharmacogenomic drug-gene interactions (DGIs) may impact the metabolism or efficacy of antihypertensive agents. We report changes in hypertension control after providing a panel of 11 pharmacogenomic predictors of antihypertensive response. Methods: A prospective cohort with CKD and hypertension was followed to assess feasibility of pharmacogenomic testing implementation, self-reported provider utilization, and blood pressure control. The analysis population included 382 hypertensive subjects genotyped for cross-sectional assessment of DGIs and 335 subjects followed for 1 year to assess systolic (SBP) and diastolic blood pressure (DBP). Results: Most participants (58.2%) with uncontrolled hypertension had a DGI reducing the efficacy of > 1 antihypertensive agent. Subjects with a DGI had 1.85-fold (95% CI 1.2-2.8) higher odds of uncontrolled hypertension as compared to those without a DGI, adjusted for race, health system (safety net hospital versus other locations) and advanced CKD (eGFR < 30 ml/min). CYP2C9 reduced metabolism genotypes were associated with losartan response and uncontrolled hypertension (Odds Ratio 5.2, CI 1.9 -14.7). CYP2D6 intermediate or poor metabolizers had less frequent uncontrolled hypertension compared to normal metabolizers taking metoprolol or carvedilol (OR 0.55, CI 0.3-0.95). In 335 subjects completing 1 year follow-up, SBP (-4.0 mmHg, CI 1.6- 6.5) and DBP (-3.3 mmHg, CI 2.0-4.6) were improved. No significant difference in SBP or DBP change were found between individuals with and without a DGI. Conclusions: There is a potential role for the addition of pharmacogenomic testing to optimize antihypertensive regimens in patients with CKD.

scholarly journals Factors associated to uncontrolled hypertension in Brazilian adults: National Health Survey

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M A Vieira ◽  
M Felisbino-Mendes ◽  
J G Velásquez-Meléndez
Keyword(s):  
Blood Pressure ◽  
Health Insurance ◽  
Health Service ◽  
Arterial Hypertension ◽  
National Health ◽  
Pharmacological Treatment ◽  
National Health Survey ◽  
Uncontrolled Hypertension ◽  
Uncontrolled Blood Pressure ◽  
Factors Associated

Abstract Background Hypertension is the main risk factor for cardiovascular diseases, contributing significantly to the increase in the number of deaths and disabilities worldwide. Moreover, hypertension control is a major action for NCDs prevention. Although pharmacological treatment has been shown effective, high rates of uncontrolled hypertension remain. The objective is to estimate the prevalence of uncontrolled arterial hypertension and the factors associated to this outcome in a representative adult Brazilian population under a pharmacological treatment. Methods This is a cross-sectional study conducted with 10,016 Brazilian adults over 18 years old who participated in the National Health Survey in Brazil carried-out in 2013. The sample comprised of residents from all Federative Units, Poisson multivariate regression was used to calculate the prevalence ratio (PR) and 95% confidence interval. Results 45% (95% CI: 44; 48) of hypertensive adults under drug treatment have uncontrolled blood pressure levels. Female gender [PR = 0.92; CI: 0.85; 0.99] and not having previous hospitalizations due to complications from hypertension or other causes [PR = 0.86; CI: 0.78; 0.94] were associated to low the prevalence of uncontrolled blood pressure. Participants aged 60 years old or more [PR = 1.31; CI:1.04; 1.64], who self-declared as black [PR = 1.19; CI: 1.04; 1.36], without health insurance [PR = 1.15; CI: 1.05; 1.27] and not attending the health service because of arterial hypertension [PR = 1.10; CI:1.01; 1.20)] presented higher prevalence of uncontrolled blood pressure. Conclusions The prevalence of uncontrolled hypertension among Brazilian adults was high among the male gender, black people, elderly, without previous hospitalizations, without health insurance and not regularly attending the health service. These results may alert the need for a reassessment of the assistance provided, in addition to raising awareness of a possible change in public policies in these groups. Key messages Evidence the magnitude of people who are at risk of hypertension even under pharmacological treatment. Highlight inequities related to the uncontrol of hypertension.

scholarly journals Characterizing Patients with Uncontrolled Blood Pressure at an Urban Hospital in Hanoi, Vietnam

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Hoang Thanh Nguyen ◽  
Nam Hoang Thi Phuong ◽  
Ngoc Tran Nguyen ◽  
Tuan Nguyen Anh ◽  
Vung Nguyen Dang
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Body Mass ◽  
Self Care ◽  
Uncontrolled Hypertension ◽  
Urban Hospital ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Uncontrolled Blood Pressure ◽  
Hypertensive Patients

Great efforts to advance the diagnosis and treatment of hypertension for controlling hypertension have been made; however, the rates of uncontrolled blood pressure are still high. This study explored the rate of uncontrolled hypertension in patients with hypertension managed in an urban hospital of Vietnam and identified associated factors. A cross-sectional survey was performed from August to October 2019 among hypertensive patients at an urban hospital in Hanoi, Vietnam. Blood pressure was evaluated at the time of medical examination. Demographic, clinical, and behavioral characteristics were also collected. Multivariate logistic regression was used to identify the factors related to uncontrolled hypertension. Among 220 patients, the rate of uncontrolled hypertension was 40.5%. Females had a lower likelihood of having uncontrolled hypertension compared to males (adjusted OR = 0.33; 95% CI = 0.11–0.98). Higher duration of diseases (adjusted OR = 1.07; 95% CI = 1.01–1.14) and higher body mass index (adjusted OR = 1.23; 95% CI = 1.05–1.45) were positively associated with uncontrolled hypertension. Patients who carried supplies needed for self-care, cut down on stress, exercised regularly, and stopped/cut down on smoking were also less likely to develop uncontrolled hypertension. This study reveals that uncontrolled hypertension was common among hypertensive patients in Vietnam. Improving self-care capacity and encouraging healthy behaviors are critically important to control blood pressure, particularly among patients who were males and had high disease duration and body mass index.

scholarly journals Beyond Medication Adherence: The Role of Patients’ Beliefs and Life Context in Blood Pressure Control

2019 ◽  
Vol 29 (4) ◽  
pp. 567-576
Author(s):  
Nancy R. Kressin ◽  
A. Rani Elwy ◽  
Mark Glickman ◽  
Michelle B. Orner ◽  
Gemmae M. Fix ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Regression Models ◽  
Pressure Control ◽  
Cross Sectional ◽  
Uncontrolled Blood Pressure ◽  
Life Context ◽  
Primary Care Patients ◽  
Race Ethnicity

Objectives: Despite numerous interven­tions to address adherence to antihyperten­sive medications, continued high rates of uncontrolled blood pressure (BP) suggest a need to better understand patient factors beyond adherence associated with BP con­trol. We examined how patients’ BP-related beliefs, and aspects of life context affect BP control, beyond medication adherence.Methods: We conducted a cross-sectional telephone survey of primary care patients with hypertension between 2010 and 2011 (N=103; 93 had complete data on all variables and were included in the regression analyses). We assessed patient so­ciodemographics (including race/ethnicity), medication adherence, BP-related beliefs, aspects of life context, and used clinical BP assessments.Results: Regression models including sociodemographics, medication adherence, and either beliefs or context consistently predicted BP control. Adding context after beliefs added no predictive value while adding beliefs after context significantly predicted BP control.Conclusion: Including patients’ BP beliefs after context had the strongest effects on BP control.Practice Implications: Results suggest that when clinicians must choose a dimen­sion on which to intervene, focusing on beliefs would be the most fruitful approach to effecting change in BP control.Ethn Dis. 2019;29(4):567-576; doi:10.18865/ ed.29.4.567

scholarly journals Arterial hypertension assessment in a population with chronic myeloid leukemia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ricardo Roa-Chamorro ◽  
Fernando Jaén-Águila ◽  
José Manuel Puerta-Puerta ◽  
Lucía Torres-Quintero ◽  
Pablo González-Bustos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Kinase Inhibitors ◽  
Blood Pressure Monitoring ◽  
Pressure Control ◽  
Cross Sectional Study ◽  
Secondary Effects ◽  
Cross Sectional ◽  
Uncontrolled Blood Pressure ◽  
Very High

AbstractTreatment of chronic myeloid leukaemia (CML) is based on tyrosine kinase inhibitors (TKI), whose introduction in 2001 improved the survival rate after 5 years from 40 to 90%. The longevity increase has been accompanied by a higher incidence of cardiovascular events (CVE) that can be explained due to the sum of cardiovascular risk factors (CVRF) together with the secondary effects of the TKI. The effect of the TKI over the blood pressure control is still unknown. An observational cross-sectional study of patients with CML under treatment with TKI (imatinib, dasatinib and nilotinib) was conducted. Blood pressure was analyzed through sphygmomanometer and 24-h ambulatory blood pressure monitoring (ABPM). A total of 73 patients were included, 57 treated with a single line of treatment. 32.9% of the total of individuals under this study showed uncontrolled blood pressure according to the ABPM. The factors related to uncontrolled BP were overweight, dyslipidemia, alcohol use, pulse wave velocity a high/very high cardiovascular risk. The subjects who received treatment with nilotinib did present worse control of their blood pressure in ABPM than those treated with imatinib and dasatinib (p = 0.041). This finding could indicate that an uncontrolled blood pressure is implied in the pro-inflammatory and pro-atherogenic mechanism underlying the development of the cardiovascular disease in those patients under treatment with nilotinib. The ABPM is a useful tool in the diagnosis and treatment of HT, being the reason why it should be included in the assessment of patients with CML whose HT diagnosis proves uncertain.

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