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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Minoxidil is an arteriolar vasodilator approved in the 1970s as a treatment of severe refractory hypertension&#44; with standard doses ranging between 10 and 40<span class="elsevierStyleHsp" style=""></span>mg daily &#40;up to 100<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Within last years&#44; low-dose oral minoxidil &#40;LDOM&#41; has been increasingly used for the treatment of different types of alopecia&#44; supported by numerous studies describing its effectiveness and favorable safety profile&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> One of the largest studies thoroughly described the frequency and chronology of adverse effects &#40;AE&#41; of LDOM treatment in 1404 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Hypertrichosis is a well-known and most common AE of LDOM&#44; appearing in approximately 15&#37; of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Although uncommon&#44; systemic AE may occur and&#44; in a minority of patients&#44; lead to discontinuation of LDOM treatment&#46; The majority of systemic AE are related with the cardiovascular and hemodynamic effect of minoxidil&#44; including lightheadedness &#40;dizziness&#44; postural hypotension&#41;&#44; fluid retention &#40;lower limb or facial edema&#41;&#44; tachycardia &#40;palpitations&#41;&#44; electrocardiogram alterations &#40;mainly in T-wave&#41;&#44; headache&#44; insomnia&#44; nightmares or increased appetite&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4&#44;6&#44;7</span></a> These AE are generally well-tolerated and resolve after discontinuation or dose adjustment of LDOM&#46; Serious AE have been reported with high doses of oral minoxidil when used for severe hypertension or due to compounding errors in hair loss treatment&#44; including hypotensive syncope&#44; pericarditis&#44; pericardial effusion or myocardial infarction&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Systemic AE represent the main concern of LDOM treatment in general population with hair loss&#44; which are mostly healthy middle-aged adults&#46; Considering that LDOM is used as an off-label therapy&#44; these safety concerns become major when prescribing it in special situations such as patients with personal history of arterial hypertension &#40;HT&#41; or arrhythmia&#46; It is still unknown whether LDOM could enhance the hypotensive effect of other antihypertensive drugs or increase the risk of systemic AE in these patients&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective of this study was to evaluate the safety of LDOM for the treatment of hair loss in patients with HT or arrhythmia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This retrospective&#44; descriptive&#44; multicenter study included adult patients with personal history of HT or arrhythmia who were under treatment with LDOM for hair loss of any cause for at least one month&#44; at five centers from Brazil and Spain&#44; from January 2018 to April 2022&#46; This minimum treatment duration of one month was established considering the previously described AE&#39;s chronology of LDOM&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Epidemiological&#44; medical&#44; and safety data were collected from patients&#8217; medical records&#44; including prior treatments for HT&#44; AE&#44; and the need to withdraw or adjust the dose of LDOM or antihypertensive treatments&#46; In some patients&#44; the dose of LDOM was titrated according to response and tolerability&#44; and the above parameters were analyzed for each dose&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Statistical analysis was performed with IBM SPSS Statistics &#40;Version 25&#46;0&#58; IBM Corp&#46;&#44; 2017&#41;&#46; Continuous variables are expressed as mean &#40;range&#41;&#46; Logistic regression was used to identify the variables associated with an increased risk of systemic AEs&#44; withdraw or adjustment of LDOM or antihypertensive treatments&#44; which was considered statistically significant if the <span class="elsevierStyleItalic">P</span>-value was<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Hypertension</span><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 254 patients &#91;176 women &#40;69&#46;3&#37;&#41; and 78 men &#40;30&#46;7&#37;&#41;&#93; with a mean age of 56&#46;9 years &#40;range 19&#8211;82&#41; were included&#46; From them&#44; the dose of LDOM was titrated at various incremental doses as tolerated in 82 patients &#40;32&#46;2&#37;&#41;&#44; allowing the analysis of 382 different doses&#46; The mean dose of LDOM was 1&#46;59<span class="elsevierStyleHsp" style=""></span>mg &#40;range 0&#46;2&#8211;10&#41; and the mean duration was 10&#46;9 months &#40;1&#8211;51&#41;&#46; LDOM was the only systemic therapy for hair loss in 124 patients &#40;48&#46;8&#37;&#41;&#46; In the remaining patients&#44; the most frequent concomitant drug was oral dutasteride&#46; The most common indication for LDOM treatment was androgenetic alopecia &#40;68&#46;9&#37;&#41;&#44; followed by frontal fibrosing alopecia &#40;10&#46;2&#37;&#41;&#44; telogen effluvium &#40;4&#46;3&#37;&#41;&#44; lichen planopilaris &#40;3&#46;5&#37;&#41;&#44; fibrosing alopecia in a pattern distribution &#40;3&#46;1&#37;&#41;&#44; alopecia areata &#40;2&#46;4&#37;&#41;&#44; and other less common types of alopecia&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Prior to LDOM treatment&#44; patients were receiving a mean of 1&#46;4 antihypertensive drugs &#40;range 0&#8211;5&#41;&#46; Only 5 patients &#40;1&#46;3&#37;&#41; were not under treatment for HT&#46; The most frequent drug class was angiotensin II receptor blockers &#40;ARBs&#41; in 190 patients &#40;49&#46;7&#37;&#41;&#44; followed by thiazides &#40;28&#46;5&#37;&#41;&#44; beta-blockers &#40;28&#37;&#41;&#44; and others &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">AE were detected in 71 patients &#40;27&#46;9&#37;&#41; with 84 doses &#40;21&#46;9&#37;&#41;&#46; The most common AE was hypertrichosis in 49 patients &#40;19&#46;2&#37;&#41; with 61 doses &#40;15&#46;9&#37;&#41;&#44; given that 7 patients &#40;2&#46;7&#37;&#41; developed hypertrichosis with several doses&#46; Systemic AE were identified in 23 patients &#40;9&#37;&#41; with 26 doses &#40;6&#46;8&#37;&#41; and included lightheadedness &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#59; 3&#46;1&#37;&#41;&#44; fluid retention &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#59; 2&#46;6&#37;&#41;&#44; general malaise &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#59; 0&#46;8&#37;&#41;&#44; tachycardia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#59; 0&#46;8&#37;&#41; and headache &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#59; 0&#46;5&#37;&#41;&#46; Five patients &#40;1&#46;9&#37;&#41; developed more than one AE&#58; hypertrichosis plus lightheadedness &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; hypertrichosis plus tachycardia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; lightheadedness plus general malaise &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; and lightheadedness plus general malaise plus fluid retention &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44; who required LDOM discontinuation&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">All of the AE improved with dose adjustment or discontinuation of the drug&#44; and no life-threatening AE were observed&#46; Dose of LDOM was decreased in 14 cases &#40;3&#46;6&#37;&#41;&#44; from whom 8 cases were due to systemic AE&#44; and 6 cases due to hypertrichosis&#46; LDOM discontinuation was required in 6 cases &#40;1&#46;5&#37;&#41; due to intense hair shedding &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; fluid retention &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; lightheadedness &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; lightheadedness plus general malaise &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; lightheadedness plus general malaise plus fluid retention &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; and tachycardia plus hypertrichosis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#59; this patient stopped LDOM because of tachycardia&#44; then restarted treatment with no systemic AE&#44; and stopped again after 1 year because of hypertrichosis&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The most frequent AE leading to LDOM adjustment or withdrawal was lightheadedness &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Hypertrichosis was associated with a higher risk of dose adjustment &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41; but not with discontinuation &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;65&#41;&#46; Age&#44; gender&#44; and dose of LDOM were no associated with the risk of systemic AE nor with adjustment of LDOM&#46; Other factors associated with LDOM adjustment and withdrawal are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Patients who received 3 or more antihypertensive drugs had a higher risk of developing more than 1 AE &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; lightheadedness &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; general malaise &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and of requiring LDOM discontinuation &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;012&#41;&#46; Also&#44; prior treatment with doxazosin was associated with a higher risk of lightheadedness &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; general malaise &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; fluid retention &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; and necessity of both dose adjustment &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41; and withdrawal of LDOM &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding antihypertensive therapy&#44; only two patients &#40;0&#46;7&#37;&#41; required an adjustment or discontinuation of their prior treatment&#46; One 67-year-old woman treated with minoxidil 0&#46;5<span class="elsevierStyleHsp" style=""></span>mg and spironolactone 50<span class="elsevierStyleHsp" style=""></span>mg daily&#44; developed symptomatic hypotension four days after changing from ramipril to olmesartan &#40;by her general practitioner&#41;&#46; Olmesartan was suspended and HT was controlled with minoxidil and spironolactone&#46; The other patient was a 71-year-old woman whose prior treatment with losartan was suspended because of a good control of her HT with minoxidil 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg daily&#46; The remaining patients did not report changes or impairment of their HT during LDOM treatment&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Arrhythmia</span><p id="par0065" class="elsevierStylePara elsevierViewall">A total of 10 patients &#40;8 women and 2 men&#41; with a median age of 61 years &#40;range 37&#8211;74&#41; were included&#46; From them&#44; the dose of LDOM was titrated in three patients&#44; allowing the analysis of 15 doses&#46; The median dose of LDOM was 0&#46;75<span class="elsevierStyleHsp" style=""></span>mg &#40;range 0&#46;25&#8211;5&#41; and the median duration was 5 months &#40;range 1&#8211;11&#41;&#46; The most frequent indication for LDOM treatment was androgenetic alopecia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&#44; followed by chronic telogen effluvium &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; and frontal fibrosing alopecia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#46; Nine patients had personal history of arrhythmia&#44; namely supraventricular extrasystole &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; atrial fibrillation &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; sinus tachycardia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; cardiac syncope &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; and unknown arrhythmia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44; missing data&#41;&#46; From them&#44; four patients were under medical treatment with beta-blockers &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; or amiodarone &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; two patients had undergone a cardiac ablation&#44; one patient had a pacemaker&#44; and two patients were not receiving any treatment&#46; The remaining patient had a mechanical aortic valve due to an aortic aneurysm repaired by Bentall procedure&#46; From these 10 patients&#44; a consultation with cardiologist was made in five of them before starting LDOM treatment&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Systemic AE were reported in only one patient with supraventricular extrasystole in treatment with carvedilol who developed periorbital and pedal edema with LDOM 1<span class="elsevierStyleHsp" style=""></span>mg&#44; which resolved after adjusting the dose to 0&#46;25<span class="elsevierStyleHsp" style=""></span>mg&#46; No patients reported palpitations&#44; worsening of their prior arrhythmia or any other cardiological AE&#44; and none of them required a modification of their prior medical treatment&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">To our knowledge&#44; this represents the first study of the safety of LDOM in patients with HT or arrhythmia&#46; Numerous studies have shown its favorable safety profile in general population&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4&#44;6</span></a> and recent studies have investigated the use of LDOM in special situations such as pediatric&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> adolescent&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and elderly population&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> but there are scarce data of its use in patients with HT or arrhythmia&#46; The global prevalence of HT in adults is 34&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> so it seems important to expand knowledge about the management and safety issues of LDOM treatment in these patients&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In our cohort of hypertensive patients treated with LDOM&#44; the global frequency and type of AE were consistent to those found in recent studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> AE were detected in 21&#46;9&#37; of the cases&#44; and hypertrichosis was the most common one &#40;15&#46;9&#37;&#41;&#44; similarly to the data found by Va&#241;o-Galvan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However&#44; we did find a higher frequency of cardiovascular AE &#40;lightheadedness and fluid retention&#41;&#44; and more patients presenting more than 1 AE &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Lightheadedness and tachycardia were significantly associated with a higher risk of both adjustment and suspension of LDOM &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Hypertrichosis was associated with dose adjustment but not with suspension&#44; supporting that this AE is usually well-tolerated&#46; Patients who were treated with three or more antihypertensive drugs had also more risk of lightheadedness and suspension of LDOM&#46; Among all antihypertensive drugs&#44; doxazosin led to a higher risk of lightheadedness&#44; fluid retention and suspension of LDOM&#46; This could be explained by the fact that doxazosin is an alpha-adrenergic blocker that also causes arteriolar vasodilation&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> which might produce a synergistic effect with minoxidil&#46; Although it might be plausible that other vasodilators&#44; such as hydralazine or calcium channel blockers&#44; could increase this synergistic effect with minoxidil&#44; we did not find a statistically significant association&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Lightheadedness &#40;also referred as dizziness or postural hypotension&#41; was the most frequent systemic AE and the most common cause of both adjustment and discontinuation of LDOM &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; It was generally mild and reported more frequently in summer and in the morning&#46; There were no cases of serious hypotension or impairment of blood pressure &#40;BP&#41; control&#46; In this regard&#44; two recent studies investigated the variation of BP in male patients treated with 5<span class="elsevierStyleHsp" style=""></span>mg LDOM using 24<span class="elsevierStyleHsp" style=""></span>h ambulatory BP monitoring&#46; They found a slight reduction in BP in the 2<span class="elsevierStyleHsp" style=""></span>h after intake of LDOM<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and at week 24&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Few additional studies have assessed BP during treatment with LDOM at doses between 0&#46;45 and 5<span class="elsevierStyleHsp" style=""></span>mg&#44; obtaining similar results&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;17</span></a> This is consistent with 1970s studies with 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#44; 5<span class="elsevierStyleHsp" style=""></span>mg and 10<span class="elsevierStyleHsp" style=""></span>mg minoxidil which found a minimal or no hypotensive effect in normotensive patients&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Fluid retention &#40;mainly pedal edema&#59; only 2 cases of facial edema&#41; was detected in our study in 2&#46;6&#37; of the patients&#44; which is a slightly higher frequency than previous studies in general population&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> but much lower than treatment with standard doses &#40;7&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We did not find a lower frequency in patients taking diuretics as antihypertensive &#40;thiazides or spironolactone&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Tachycardia was only detected in 0&#46;8&#37; of the patients with hypertension&#44; all of them requiring adjustment or suspension of LDOM&#46; Tachycardia is the result of reflex sympathetic activation induced by the vasodilatory effect of oral minoxidil&#44; and it is traditionally described as a frequent AE with standard doses&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; studies with LDOM have shown that palpitations are rather uncommon and transient&#44; usually appearing within the first intakes of LDOM&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;7&#44;15&#44;17</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">EKG changes are another common AE with standard doses of minoxidil&#44; with changes in direction and magnitude of the T-waves in up to 60&#37; of patients&#44; mainly due to a coronary steal mechanism associated with the reduction of blood pressure in the coronary arteries&#46; They are asymptomatic&#44; and usually disappear despite continuation of the treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Only a few studies have performed EKG in patients with LDOM&#46; One study from Thailand found asymptomatic T-wave changes in 10&#8211;20&#37; of the patients &#40;non-ischemic T wave inversion in one lead&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Sanabria et al&#46; found a non-significant increasing in the occurrence of supraventricular and ventricular extrasystole after 24 weeks of treatment with 5<span class="elsevierStyleHsp" style=""></span>mg LDOM&#44; with no remarkable alterations in ventricular repolarization in the 24-h Holter monitoring&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Interestingly&#44; from our cohort of patients with arrhythmia&#44; no patients reported palpitations or worsening of their prior disease&#46; We did not perform routine EKG in these patients&#44; but five of them were referred to their Cardiologist who approved treatment with LDOM&#46; However&#44; extreme caution should be taken in patients with coronary disease or chronic heart failure since tachycardia may limit myocardium oxygenation &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Consistently with previous studies of LDOM&#44; we did not detect any serious cardiovascular AE such as syncope&#44; ischemic heart disease&#44; pericarditis&#44; or pericardial effusion&#46; These AE were described with standard doses of minoxidil&#44; but they occurred mainly in patients with underlying diseases such as systemic lupus erythematous&#44; advanced renal disease or congestive heart failure&#44; and are extremely rare with LDOM&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Based on our results&#44; the clinical experience of the authors in LDOM treatment&#44; and the collaboration of a cardiologist in this study &#40;MR&#41;&#44; most patients undergoing treatment for HT may start LDOM without previous referral to cardiologist&#46; However&#44; we suggest some recommendations for the management of LDOM therapy in patients with HT or arrhythmia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The limitations of this study were the retrospective design&#44; lack of a control group and lack of objective measurement of blood pressure and EKG&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In conclusion&#44; LDOM treatment showed a favorable safety profile in patients with HT or arrhythmia&#44; similar to general population&#46; Most common systemic AE were lightheadedness and fluid retention&#44; which improved after adjustment or withdrawal of LDOM&#46; Combination of LDOM with 3 or more antihypertensive drugs or with doxazosin was associated with a higher risk of these systemic AE&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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            0 => array:2 [
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              "titulo" => "Background and objective"
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          "titulo" => "Resumen"
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              "titulo" => "Hypertension"
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              "titulo" => "Arrhythmia"
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    "fechaRecibido" => "2023-06-23"
    "fechaAceptado" => "2023-07-20"
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          "clase" => "keyword"
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          "palabras" => array:7 [
            0 => "Androgenetic alopecia"
            1 => "Hypotension"
            2 => "Arterial hypertension"
            3 => "Blood pressure"
            4 => "Hair loss"
            5 => "Arrhythmia"
            6 => "Heart disease"
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          "clase" => "keyword"
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          "palabras" => array:7 [
            0 => "Alopecia androg&#233;nica"
            1 => "Hipotensi&#243;n"
            2 => "Hipertensi&#243;n arterial"
            3 => "Presi&#243;n arterial"
            4 => "Alopecia"
            5 => "Arritmia"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Background and objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Systemic adverse effects &#40;AE&#41; are a major concern of low-dose oral minoxidil &#40;LDOM&#41; treatment&#44; especially in patients with arterial hypertension or arrhythmia&#46; The objective of this study was to evaluate the safety of LDOM in patients with hypertension or arrhythmia&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Patients and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Retrospective multicenter study of patients with hypertension or arrhythmia treated with LDOM for any type of alopecia&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A total of 254 patients with hypertension &#91;176 women &#40;69&#46;3&#37;&#41; and 78 men &#40;30&#46;7&#37;&#41;&#93; with a mean age of 56&#46;9 years &#40;range 19&#8211;82&#41; were included&#46; From them&#44; the dose of LDOM was titrated in 128 patients&#44; allowing the analysis of 382 doses&#46; Patients were receiving a mean of 1&#46;45 &#40;range 0&#8211;5&#41; antihypertensive drugs&#46; Systemic AE were detected in 26 cases &#40;6&#46;8&#37;&#41; and included lightheadedness &#40;3&#46;1&#37;&#41;&#44; fluid retention &#40;2&#46;6&#37;&#41;&#44; general malaise &#40;0&#46;8&#37;&#41;&#44; tachycardia &#40;0&#46;8&#37;&#41; and headache &#40;0&#46;5&#37;&#41;&#44; leading to LDOM discontinuation in 6 cases &#40;1&#46;5&#37;&#41;&#46; Prior treatment with doxazosin &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; or with three or more antihypertensive drugs &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;012&#41; was associated with a higher risk of discontinuation of LDOM&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">LDOM treatment showed a favorable safety profile in patients with hypertension or arrhythmia&#44; similar to general population&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Patients and methods"
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          2 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes y objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los efectos adversos sist&#233;micos son una de las principales limitaciones del uso de minoxidil oral a dosis bajas &#40;MODB&#41;&#44; especialmente en pacientes con hipertensi&#243;n arterial o arritmias&#46; El objetivo de este estudio fue evaluar la seguridad de MODB en estos pacientes&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material y m&#233;todo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo multic&#233;ntrico con pacientes con antecedentes de hipertensi&#243;n o arritmias tratados con MODB para cualquier tipo de alopecia&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; un total de 254 pacientes con hipertensi&#243;n &#40;176 mujeres &#91;69&#44;3&#37;&#93; y 78 hombres &#91;30&#44;7&#37;&#93;&#41; con una edad media de 56&#44;9 a&#241;os &#40;rango 19 &#8211; 82&#41;&#46; La dosis de MODB se increment&#243; gradualmente en 128 pacientes&#44; obteniendo un total de 382 dosis analizadas&#46; Los sujetos estaban tomando de media 1&#44;45 f&#225;rmacos antihipertensivos &#40;rango 0 &#8211; 5&#41;&#46; Se detectaron EA sist&#233;micos en 26 casos &#40;6&#44;8&#37;&#41;&#44; incluyendo mareo &#40;3&#44;1&#37;&#41;&#44; retenci&#243;n de l&#237;quidos &#40;2&#44;6&#37;&#41;&#44; malestar general &#40;0&#44;8&#37;&#41;&#44; taquicardia &#40;0&#44;8&#37;&#41; y cefalea &#40;0&#44;5&#37;&#41;&#44; requiriendo suspensi&#243;n del MODB en seis casos &#40;1&#44;5&#37;&#41;&#46; Los pacientes en tratamiento con doxazosina &#40;p &#60; 0&#44;001&#41; o con tres o m&#225;s antihipertensivos &#40;p &#61; 0&#44;012&#41; presentaron mayor riesgo de suspensi&#243;n de MODB&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusi&#243;n</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El tratamiento con MODB mostr&#243; un perfil de seguridad favorable en pacientes con hipertensi&#243;n o arritmias&#44; similar al de la poblaci&#243;n general&#46;</p></span>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Flowchart describing the type and frequency of adverse effects&#44; dose adjustment and discontinuation of LDOM treatment in hypertensive patients&#46; &#42; Sum of individual frequencies may differ from total frequency because some patients developed more than one adverse effect&#46;</p>"
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        "etiqueta" => "Figure 2"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Recommendations for the management of LDOM therapy in patients with hypertension or arrhythmia &#40;based on authors&#8217; clinical experience and results of this study&#41;&#46; <span class="elsevierStyleSup">a</span> Cardiologist&#39;s comment&#58; dermatologist may consider decreasing the dose or changing the hour intake of prior antihypertensive drug if the patient develops lightheadedness&#46; <span class="elsevierStyleSup">b</span> Contraindications according to minoxidil product monograph&#46; <span class="elsevierStyleSup">c</span> Cardiologist&#39;s comment&#58; LDOM could be used after a myocardial infarction only once a stable post-infarction state has been achieved &#40;12 months after&#41;&#46; Do not use if non-revascularized angina&#47;ischemic event&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ACE&#58; angiotensin-converting enzyme&#59; AE&#58; adverse effects&#59; ARBs&#58; angiotensin II receptor blockers&#59; LDOM&#58; low-dose oral minoxidil&#59; <span class="elsevierStyleItalic">P</span> value considered statistically significant if &#60;0&#46;05 &#40;bold&#41;&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Require discontinuation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Total</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">382&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14&#47;382 &#40;3&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">6&#47;382 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gender</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;367&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;352&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">277 &#40;72&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#47;277&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;277&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Men&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">105 &#40;27&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#47;105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#47;105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age&#44; mean &#40;range&#41;&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">56&#46;9 &#40;19&#8211;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;79 years &#40;45&#8211;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;33 years &#40;49&#8211;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Minoxidil &#40;LDOM&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dose&#44; mean &#40;range&#41;&#44; mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;59 &#40;0&#46;2&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;46<span class="elsevierStyleHsp" style=""></span>mg &#40;0&#46;42&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;29<span class="elsevierStyleHsp" style=""></span>mg &#40;0&#46;5&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Duration&#44; mean &#40;range&#41;&#44; months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;9 &#40;1&#8211;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;7 &#40;1&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;5 &#40;1&#8211;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Compound LDOM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">353 &#40;92&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#47;353&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;353&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LDOM monotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">187 &#40;49&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#47;187&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;187&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Adverse effects &#40;AE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;21&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#47;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;1 AE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;1&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;024</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertrichosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;15&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lightheadedness&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tachycardia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Antihypertensive drug&#44; mean number &#40;range&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0 drugs&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1 drug&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2 drugs&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age&#44; mean</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">56&#46;9 years</span> &#40;19&#8211;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 years &#40;8&#8211;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">LDOM dose&#44; mean</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;59<span class="elsevierStyleHsp" style=""></span>mg &#40;0&#46;2&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;63<span class="elsevierStyleHsp" style=""></span>mg &#40;0&#46;03&#8211;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Adverse effects</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertrichosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Systemic AE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">6&#46;8&#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lightheadedness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">3&#46;1&#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fluid retention &#40;periorbital or ankle&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">2&#46;6&#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tachycardia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>General malaise&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Headache&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>More than 1 AE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">1&#46;9&#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">LDOM withdrawal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertricosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intense hair shedding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;08&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Systemic AE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Description of frequency of adverse effects and discontinuation of low-dose oral minoxidil &#40;LDOM&#41; found in hypertensive patients &#40;current study&#41; and those found in general population &#40;Va&#241;o-Galvan&#39;s study&#41;&#46;</p>"
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Original Article
Safety of Low-Dose Oral Minoxidil in Patients With Hypertension and Arrhythmia: A Multicenter Study of 264 Patients
Seguridad de minoxidil oral a dosis bajas en pacientes con hipertensión o arritmias: estudio multicéntrico de 264 pacientes
J. Jimenez-Cauhea,b, R. Pirmezc, P. Müller-Ramosd, D.F. Meloe, D. Ortega-Quijanoa,b, O.M. Moreno-Arronesa,b, D. Saceda-Corraloa,b,
Corresponding author
d.saceda@gmail.com

Corresponding author.
, R. Gil-Redondob,f, A. Hermosa-Gelbarda,b, B. Dias-Sanabriag, D. Restomc, M.L. Porriño-Bustamanteb, C. Pindado-Ortegaa,b, E. Berna-Ricoa, D. Fernandez-Nietoa,b, M. Ramosh, P. Jaen-Olasoloa,b, S. Vaño-Galvana,b
a Dermatology Department, Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Spain
b Trichology Unit, Grupo de Dermatologia Pedro Jaen, Madrid, Spain
c Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
d Universidade Estadual Paulista – UNESP, Botucatu, São Paulo, Brazil
e Dermatology Department, University of State of Rio de Janeiro (UERJ), Spain
f Dermatology Department, Hospital Universitario La Paz, Madrid, Spain
g Universidade Federal do Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
h Cardiology Department, Hospital Universitario de la Cruz Roja San Jose y Santa Adela, Universidad Alfonso X El Sabio, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Minoxidil is an arteriolar vasodilator approved in the 1970s as a treatment of severe refractory hypertension&#44; with standard doses ranging between 10 and 40<span class="elsevierStyleHsp" style=""></span>mg daily &#40;up to 100<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Within last years&#44; low-dose oral minoxidil &#40;LDOM&#41; has been increasingly used for the treatment of different types of alopecia&#44; supported by numerous studies describing its effectiveness and favorable safety profile&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> One of the largest studies thoroughly described the frequency and chronology of adverse effects &#40;AE&#41; of LDOM treatment in 1404 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Hypertrichosis is a well-known and most common AE of LDOM&#44; appearing in approximately 15&#37; of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Although uncommon&#44; systemic AE may occur and&#44; in a minority of patients&#44; lead to discontinuation of LDOM treatment&#46; The majority of systemic AE are related with the cardiovascular and hemodynamic effect of minoxidil&#44; including lightheadedness &#40;dizziness&#44; postural hypotension&#41;&#44; fluid retention &#40;lower limb or facial edema&#41;&#44; tachycardia &#40;palpitations&#41;&#44; electrocardiogram alterations &#40;mainly in T-wave&#41;&#44; headache&#44; insomnia&#44; nightmares or increased appetite&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4&#44;6&#44;7</span></a> These AE are generally well-tolerated and resolve after discontinuation or dose adjustment of LDOM&#46; Serious AE have been reported with high doses of oral minoxidil when used for severe hypertension or due to compounding errors in hair loss treatment&#44; including hypotensive syncope&#44; pericarditis&#44; pericardial effusion or myocardial infarction&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Systemic AE represent the main concern of LDOM treatment in general population with hair loss&#44; which are mostly healthy middle-aged adults&#46; Considering that LDOM is used as an off-label therapy&#44; these safety concerns become major when prescribing it in special situations such as patients with personal history of arterial hypertension &#40;HT&#41; or arrhythmia&#46; It is still unknown whether LDOM could enhance the hypotensive effect of other antihypertensive drugs or increase the risk of systemic AE in these patients&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective of this study was to evaluate the safety of LDOM for the treatment of hair loss in patients with HT or arrhythmia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This retrospective&#44; descriptive&#44; multicenter study included adult patients with personal history of HT or arrhythmia who were under treatment with LDOM for hair loss of any cause for at least one month&#44; at five centers from Brazil and Spain&#44; from January 2018 to April 2022&#46; This minimum treatment duration of one month was established considering the previously described AE&#39;s chronology of LDOM&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Epidemiological&#44; medical&#44; and safety data were collected from patients&#8217; medical records&#44; including prior treatments for HT&#44; AE&#44; and the need to withdraw or adjust the dose of LDOM or antihypertensive treatments&#46; In some patients&#44; the dose of LDOM was titrated according to response and tolerability&#44; and the above parameters were analyzed for each dose&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Statistical analysis was performed with IBM SPSS Statistics &#40;Version 25&#46;0&#58; IBM Corp&#46;&#44; 2017&#41;&#46; Continuous variables are expressed as mean &#40;range&#41;&#46; Logistic regression was used to identify the variables associated with an increased risk of systemic AEs&#44; withdraw or adjustment of LDOM or antihypertensive treatments&#44; which was considered statistically significant if the <span class="elsevierStyleItalic">P</span>-value was<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Hypertension</span><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 254 patients &#91;176 women &#40;69&#46;3&#37;&#41; and 78 men &#40;30&#46;7&#37;&#41;&#93; with a mean age of 56&#46;9 years &#40;range 19&#8211;82&#41; were included&#46; From them&#44; the dose of LDOM was titrated at various incremental doses as tolerated in 82 patients &#40;32&#46;2&#37;&#41;&#44; allowing the analysis of 382 different doses&#46; The mean dose of LDOM was 1&#46;59<span class="elsevierStyleHsp" style=""></span>mg &#40;range 0&#46;2&#8211;10&#41; and the mean duration was 10&#46;9 months &#40;1&#8211;51&#41;&#46; LDOM was the only systemic therapy for hair loss in 124 patients &#40;48&#46;8&#37;&#41;&#46; In the remaining patients&#44; the most frequent concomitant drug was oral dutasteride&#46; The most common indication for LDOM treatment was androgenetic alopecia &#40;68&#46;9&#37;&#41;&#44; followed by frontal fibrosing alopecia &#40;10&#46;2&#37;&#41;&#44; telogen effluvium &#40;4&#46;3&#37;&#41;&#44; lichen planopilaris &#40;3&#46;5&#37;&#41;&#44; fibrosing alopecia in a pattern distribution &#40;3&#46;1&#37;&#41;&#44; alopecia areata &#40;2&#46;4&#37;&#41;&#44; and other less common types of alopecia&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Prior to LDOM treatment&#44; patients were receiving a mean of 1&#46;4 antihypertensive drugs &#40;range 0&#8211;5&#41;&#46; Only 5 patients &#40;1&#46;3&#37;&#41; were not under treatment for HT&#46; The most frequent drug class was angiotensin II receptor blockers &#40;ARBs&#41; in 190 patients &#40;49&#46;7&#37;&#41;&#44; followed by thiazides &#40;28&#46;5&#37;&#41;&#44; beta-blockers &#40;28&#37;&#41;&#44; and others &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">AE were detected in 71 patients &#40;27&#46;9&#37;&#41; with 84 doses &#40;21&#46;9&#37;&#41;&#46; The most common AE was hypertrichosis in 49 patients &#40;19&#46;2&#37;&#41; with 61 doses &#40;15&#46;9&#37;&#41;&#44; given that 7 patients &#40;2&#46;7&#37;&#41; developed hypertrichosis with several doses&#46; Systemic AE were identified in 23 patients &#40;9&#37;&#41; with 26 doses &#40;6&#46;8&#37;&#41; and included lightheadedness &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#59; 3&#46;1&#37;&#41;&#44; fluid retention &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#59; 2&#46;6&#37;&#41;&#44; general malaise &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#59; 0&#46;8&#37;&#41;&#44; tachycardia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#59; 0&#46;8&#37;&#41; and headache &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#59; 0&#46;5&#37;&#41;&#46; Five patients &#40;1&#46;9&#37;&#41; developed more than one AE&#58; hypertrichosis plus lightheadedness &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; hypertrichosis plus tachycardia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; lightheadedness plus general malaise &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; and lightheadedness plus general malaise plus fluid retention &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44; who required LDOM discontinuation&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">All of the AE improved with dose adjustment or discontinuation of the drug&#44; and no life-threatening AE were observed&#46; Dose of LDOM was decreased in 14 cases &#40;3&#46;6&#37;&#41;&#44; from whom 8 cases were due to systemic AE&#44; and 6 cases due to hypertrichosis&#46; LDOM discontinuation was required in 6 cases &#40;1&#46;5&#37;&#41; due to intense hair shedding &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; fluid retention &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; lightheadedness &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; lightheadedness plus general malaise &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; lightheadedness plus general malaise plus fluid retention &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; and tachycardia plus hypertrichosis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#59; this patient stopped LDOM because of tachycardia&#44; then restarted treatment with no systemic AE&#44; and stopped again after 1 year because of hypertrichosis&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The most frequent AE leading to LDOM adjustment or withdrawal was lightheadedness &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Hypertrichosis was associated with a higher risk of dose adjustment &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41; but not with discontinuation &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;65&#41;&#46; Age&#44; gender&#44; and dose of LDOM were no associated with the risk of systemic AE nor with adjustment of LDOM&#46; Other factors associated with LDOM adjustment and withdrawal are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Patients who received 3 or more antihypertensive drugs had a higher risk of developing more than 1 AE &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; lightheadedness &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; general malaise &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and of requiring LDOM discontinuation &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;012&#41;&#46; Also&#44; prior treatment with doxazosin was associated with a higher risk of lightheadedness &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; general malaise &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; fluid retention &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; and necessity of both dose adjustment &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41; and withdrawal of LDOM &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding antihypertensive therapy&#44; only two patients &#40;0&#46;7&#37;&#41; required an adjustment or discontinuation of their prior treatment&#46; One 67-year-old woman treated with minoxidil 0&#46;5<span class="elsevierStyleHsp" style=""></span>mg and spironolactone 50<span class="elsevierStyleHsp" style=""></span>mg daily&#44; developed symptomatic hypotension four days after changing from ramipril to olmesartan &#40;by her general practitioner&#41;&#46; Olmesartan was suspended and HT was controlled with minoxidil and spironolactone&#46; The other patient was a 71-year-old woman whose prior treatment with losartan was suspended because of a good control of her HT with minoxidil 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg daily&#46; The remaining patients did not report changes or impairment of their HT during LDOM treatment&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Arrhythmia</span><p id="par0065" class="elsevierStylePara elsevierViewall">A total of 10 patients &#40;8 women and 2 men&#41; with a median age of 61 years &#40;range 37&#8211;74&#41; were included&#46; From them&#44; the dose of LDOM was titrated in three patients&#44; allowing the analysis of 15 doses&#46; The median dose of LDOM was 0&#46;75<span class="elsevierStyleHsp" style=""></span>mg &#40;range 0&#46;25&#8211;5&#41; and the median duration was 5 months &#40;range 1&#8211;11&#41;&#46; The most frequent indication for LDOM treatment was androgenetic alopecia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&#44; followed by chronic telogen effluvium &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; and frontal fibrosing alopecia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#46; Nine patients had personal history of arrhythmia&#44; namely supraventricular extrasystole &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; atrial fibrillation &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; sinus tachycardia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; cardiac syncope &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; and unknown arrhythmia &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44; missing data&#41;&#46; From them&#44; four patients were under medical treatment with beta-blockers &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; or amiodarone &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; two patients had undergone a cardiac ablation&#44; one patient had a pacemaker&#44; and two patients were not receiving any treatment&#46; The remaining patient had a mechanical aortic valve due to an aortic aneurysm repaired by Bentall procedure&#46; From these 10 patients&#44; a consultation with cardiologist was made in five of them before starting LDOM treatment&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Systemic AE were reported in only one patient with supraventricular extrasystole in treatment with carvedilol who developed periorbital and pedal edema with LDOM 1<span class="elsevierStyleHsp" style=""></span>mg&#44; which resolved after adjusting the dose to 0&#46;25<span class="elsevierStyleHsp" style=""></span>mg&#46; No patients reported palpitations&#44; worsening of their prior arrhythmia or any other cardiological AE&#44; and none of them required a modification of their prior medical treatment&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">To our knowledge&#44; this represents the first study of the safety of LDOM in patients with HT or arrhythmia&#46; Numerous studies have shown its favorable safety profile in general population&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4&#44;6</span></a> and recent studies have investigated the use of LDOM in special situations such as pediatric&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> adolescent&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and elderly population&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> but there are scarce data of its use in patients with HT or arrhythmia&#46; The global prevalence of HT in adults is 34&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> so it seems important to expand knowledge about the management and safety issues of LDOM treatment in these patients&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In our cohort of hypertensive patients treated with LDOM&#44; the global frequency and type of AE were consistent to those found in recent studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> AE were detected in 21&#46;9&#37; of the cases&#44; and hypertrichosis was the most common one &#40;15&#46;9&#37;&#41;&#44; similarly to the data found by Va&#241;o-Galvan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However&#44; we did find a higher frequency of cardiovascular AE &#40;lightheadedness and fluid retention&#41;&#44; and more patients presenting more than 1 AE &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Lightheadedness and tachycardia were significantly associated with a higher risk of both adjustment and suspension of LDOM &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Hypertrichosis was associated with dose adjustment but not with suspension&#44; supporting that this AE is usually well-tolerated&#46; Patients who were treated with three or more antihypertensive drugs had also more risk of lightheadedness and suspension of LDOM&#46; Among all antihypertensive drugs&#44; doxazosin led to a higher risk of lightheadedness&#44; fluid retention and suspension of LDOM&#46; This could be explained by the fact that doxazosin is an alpha-adrenergic blocker that also causes arteriolar vasodilation&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> which might produce a synergistic effect with minoxidil&#46; Although it might be plausible that other vasodilators&#44; such as hydralazine or calcium channel blockers&#44; could increase this synergistic effect with minoxidil&#44; we did not find a statistically significant association&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Lightheadedness &#40;also referred as dizziness or postural hypotension&#41; was the most frequent systemic AE and the most common cause of both adjustment and discontinuation of LDOM &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; It was generally mild and reported more frequently in summer and in the morning&#46; There were no cases of serious hypotension or impairment of blood pressure &#40;BP&#41; control&#46; In this regard&#44; two recent studies investigated the variation of BP in male patients treated with 5<span class="elsevierStyleHsp" style=""></span>mg LDOM using 24<span class="elsevierStyleHsp" style=""></span>h ambulatory BP monitoring&#46; They found a slight reduction in BP in the 2<span class="elsevierStyleHsp" style=""></span>h after intake of LDOM<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and at week 24&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Few additional studies have assessed BP during treatment with LDOM at doses between 0&#46;45 and 5<span class="elsevierStyleHsp" style=""></span>mg&#44; obtaining similar results&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;17</span></a> This is consistent with 1970s studies with 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#44; 5<span class="elsevierStyleHsp" style=""></span>mg and 10<span class="elsevierStyleHsp" style=""></span>mg minoxidil which found a minimal or no hypotensive effect in normotensive patients&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Fluid retention &#40;mainly pedal edema&#59; only 2 cases of facial edema&#41; was detected in our study in 2&#46;6&#37; of the patients&#44; which is a slightly higher frequency than previous studies in general population&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> but much lower than treatment with standard doses &#40;7&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We did not find a lower frequency in patients taking diuretics as antihypertensive &#40;thiazides or spironolactone&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Tachycardia was only detected in 0&#46;8&#37; of the patients with hypertension&#44; all of them requiring adjustment or suspension of LDOM&#46; Tachycardia is the result of reflex sympathetic activation induced by the vasodilatory effect of oral minoxidil&#44; and it is traditionally described as a frequent AE with standard doses&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; studies with LDOM have shown that palpitations are rather uncommon and transient&#44; usually appearing within the first intakes of LDOM&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;7&#44;15&#44;17</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">EKG changes are another common AE with standard doses of minoxidil&#44; with changes in direction and magnitude of the T-waves in up to 60&#37; of patients&#44; mainly due to a coronary steal mechanism associated with the reduction of blood pressure in the coronary arteries&#46; They are asymptomatic&#44; and usually disappear despite continuation of the treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Only a few studies have performed EKG in patients with LDOM&#46; One study from Thailand found asymptomatic T-wave changes in 10&#8211;20&#37; of the patients &#40;non-ischemic T wave inversion in one lead&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Sanabria et al&#46; found a non-significant increasing in the occurrence of supraventricular and ventricular extrasystole after 24 weeks of treatment with 5<span class="elsevierStyleHsp" style=""></span>mg LDOM&#44; with no remarkable alterations in ventricular repolarization in the 24-h Holter monitoring&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Interestingly&#44; from our cohort of patients with arrhythmia&#44; no patients reported palpitations or worsening of their prior disease&#46; We did not perform routine EKG in these patients&#44; but five of them were referred to their Cardiologist who approved treatment with LDOM&#46; However&#44; extreme caution should be taken in patients with coronary disease or chronic heart failure since tachycardia may limit myocardium oxygenation &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Consistently with previous studies of LDOM&#44; we did not detect any serious cardiovascular AE such as syncope&#44; ischemic heart disease&#44; pericarditis&#44; or pericardial effusion&#46; These AE were described with standard doses of minoxidil&#44; but they occurred mainly in patients with underlying diseases such as systemic lupus erythematous&#44; advanced renal disease or congestive heart failure&#44; and are extremely rare with LDOM&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Based on our results&#44; the clinical experience of the authors in LDOM treatment&#44; and the collaboration of a cardiologist in this study &#40;MR&#41;&#44; most patients undergoing treatment for HT may start LDOM without previous referral to cardiologist&#46; However&#44; we suggest some recommendations for the management of LDOM therapy in patients with HT or arrhythmia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The limitations of this study were the retrospective design&#44; lack of a control group and lack of objective measurement of blood pressure and EKG&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In conclusion&#44; LDOM treatment showed a favorable safety profile in patients with HT or arrhythmia&#44; similar to general population&#46; Most common systemic AE were lightheadedness and fluid retention&#44; which improved after adjustment or withdrawal of LDOM&#46; Combination of LDOM with 3 or more antihypertensive drugs or with doxazosin was associated with a higher risk of these systemic AE&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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              "titulo" => "Hypertension"
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              "titulo" => "Arrhythmia"
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    "fechaRecibido" => "2023-06-23"
    "fechaAceptado" => "2023-07-20"
    "PalabrasClave" => array:2 [
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          "clase" => "keyword"
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          "palabras" => array:7 [
            0 => "Androgenetic alopecia"
            1 => "Hypotension"
            2 => "Arterial hypertension"
            3 => "Blood pressure"
            4 => "Hair loss"
            5 => "Arrhythmia"
            6 => "Heart disease"
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec1764121"
          "palabras" => array:7 [
            0 => "Alopecia androg&#233;nica"
            1 => "Hipotensi&#243;n"
            2 => "Hipertensi&#243;n arterial"
            3 => "Presi&#243;n arterial"
            4 => "Alopecia"
            5 => "Arritmia"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Background and objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Systemic adverse effects &#40;AE&#41; are a major concern of low-dose oral minoxidil &#40;LDOM&#41; treatment&#44; especially in patients with arterial hypertension or arrhythmia&#46; The objective of this study was to evaluate the safety of LDOM in patients with hypertension or arrhythmia&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Patients and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Retrospective multicenter study of patients with hypertension or arrhythmia treated with LDOM for any type of alopecia&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A total of 254 patients with hypertension &#91;176 women &#40;69&#46;3&#37;&#41; and 78 men &#40;30&#46;7&#37;&#41;&#93; with a mean age of 56&#46;9 years &#40;range 19&#8211;82&#41; were included&#46; From them&#44; the dose of LDOM was titrated in 128 patients&#44; allowing the analysis of 382 doses&#46; Patients were receiving a mean of 1&#46;45 &#40;range 0&#8211;5&#41; antihypertensive drugs&#46; Systemic AE were detected in 26 cases &#40;6&#46;8&#37;&#41; and included lightheadedness &#40;3&#46;1&#37;&#41;&#44; fluid retention &#40;2&#46;6&#37;&#41;&#44; general malaise &#40;0&#46;8&#37;&#41;&#44; tachycardia &#40;0&#46;8&#37;&#41; and headache &#40;0&#46;5&#37;&#41;&#44; leading to LDOM discontinuation in 6 cases &#40;1&#46;5&#37;&#41;&#46; Prior treatment with doxazosin &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; or with three or more antihypertensive drugs &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;012&#41; was associated with a higher risk of discontinuation of LDOM&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">LDOM treatment showed a favorable safety profile in patients with hypertension or arrhythmia&#44; similar to general population&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Background and objective"
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          1 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Patients and methods"
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            "identificador" => "abst0020"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes y objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los efectos adversos sist&#233;micos son una de las principales limitaciones del uso de minoxidil oral a dosis bajas &#40;MODB&#41;&#44; especialmente en pacientes con hipertensi&#243;n arterial o arritmias&#46; El objetivo de este estudio fue evaluar la seguridad de MODB en estos pacientes&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material y m&#233;todo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo multic&#233;ntrico con pacientes con antecedentes de hipertensi&#243;n o arritmias tratados con MODB para cualquier tipo de alopecia&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; un total de 254 pacientes con hipertensi&#243;n &#40;176 mujeres &#91;69&#44;3&#37;&#93; y 78 hombres &#91;30&#44;7&#37;&#93;&#41; con una edad media de 56&#44;9 a&#241;os &#40;rango 19 &#8211; 82&#41;&#46; La dosis de MODB se increment&#243; gradualmente en 128 pacientes&#44; obteniendo un total de 382 dosis analizadas&#46; Los sujetos estaban tomando de media 1&#44;45 f&#225;rmacos antihipertensivos &#40;rango 0 &#8211; 5&#41;&#46; Se detectaron EA sist&#233;micos en 26 casos &#40;6&#44;8&#37;&#41;&#44; incluyendo mareo &#40;3&#44;1&#37;&#41;&#44; retenci&#243;n de l&#237;quidos &#40;2&#44;6&#37;&#41;&#44; malestar general &#40;0&#44;8&#37;&#41;&#44; taquicardia &#40;0&#44;8&#37;&#41; y cefalea &#40;0&#44;5&#37;&#41;&#44; requiriendo suspensi&#243;n del MODB en seis casos &#40;1&#44;5&#37;&#41;&#46; Los pacientes en tratamiento con doxazosina &#40;p &#60; 0&#44;001&#41; o con tres o m&#225;s antihipertensivos &#40;p &#61; 0&#44;012&#41; presentaron mayor riesgo de suspensi&#243;n de MODB&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusi&#243;n</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El tratamiento con MODB mostr&#243; un perfil de seguridad favorable en pacientes con hipertensi&#243;n o arritmias&#44; similar al de la poblaci&#243;n general&#46;</p></span>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Flowchart describing the type and frequency of adverse effects&#44; dose adjustment and discontinuation of LDOM treatment in hypertensive patients&#46; &#42; Sum of individual frequencies may differ from total frequency because some patients developed more than one adverse effect&#46;</p>"
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        "etiqueta" => "Figure 2"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Recommendations for the management of LDOM therapy in patients with hypertension or arrhythmia &#40;based on authors&#8217; clinical experience and results of this study&#41;&#46; <span class="elsevierStyleSup">a</span> Cardiologist&#39;s comment&#58; dermatologist may consider decreasing the dose or changing the hour intake of prior antihypertensive drug if the patient develops lightheadedness&#46; <span class="elsevierStyleSup">b</span> Contraindications according to minoxidil product monograph&#46; <span class="elsevierStyleSup">c</span> Cardiologist&#39;s comment&#58; LDOM could be used after a myocardial infarction only once a stable post-infarction state has been achieved &#40;12 months after&#41;&#46; Do not use if non-revascularized angina&#47;ischemic event&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ACE&#58; angiotensin-converting enzyme&#59; AE&#58; adverse effects&#59; ARBs&#58; angiotensin II receptor blockers&#59; LDOM&#58; low-dose oral minoxidil&#59; <span class="elsevierStyleItalic">P</span> value considered statistically significant if &#60;0&#46;05 &#40;bold&#41;&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3&#47;277&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Men&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">105 &#40;27&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#47;105&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#47;105&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age&#44; mean &#40;range&#41;&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">56&#46;9 &#40;19&#8211;82&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">58&#46;79 years &#40;45&#8211;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">61&#46;33 years &#40;49&#8211;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Minoxidil &#40;LDOM&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dose&#44; mean &#40;range&#41;&#44; mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;59 &#40;0&#46;2&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;46<span class="elsevierStyleHsp" style=""></span>mg &#40;0&#46;42&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;92&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;29<span class="elsevierStyleHsp" style=""></span>mg &#40;0&#46;5&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Duration&#44; mean &#40;range&#41;&#44; months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">10&#46;9 &#40;1&#8211;51&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;7 &#40;1&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;51&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;5 &#40;1&#8211;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Compound LDOM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">353 &#40;92&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13&#47;353&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;94&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#47;353&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;39&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LDOM monotherapy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">187 &#40;49&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#47;187&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;53&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#47;187&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Adverse effects &#40;AE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">84 &#40;21&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">14&#47;84&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#47;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;1 AE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">7 &#40;1&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&#47;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;024</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">3&#47;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertrichosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">61 &#40;15&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#47;61&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;003</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#47;61<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;651&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intense shedding&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1 &#40;0&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#47;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Systemic AE</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">26 &#40;6&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Antihypertensive drug&#44; mean number &#40;range&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3 or more drug&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#47;190&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Systemic AE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">6&#46;8&#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lightheadedness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">3&#46;1&#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fluid retention &#40;periorbital or ankle&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">2&#46;6&#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tachycardia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">0&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>More than 1 AE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">1&#46;9&#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">0&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;08&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
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ISSN: 00017310
Original language: English
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