***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To assess the effects of weight reduction with 10 mg of sibutramine or placebo on blood pressure during 24 hours ( ambulatory blood pressure monitoring ) , on left ventricular mass , and on antihypertensive therapy in 86 obese and hypertensive patients for 6 months . METHODS The patients underwent echocardiography , ambulatory blood pressure monitoring , and measurement of the levels of hepatic enzymes  prior to and after treatment with sibutramine or placebo . RESULTS The group using sibutramine had a greater weight loss than that using placebo ( 6.7 % versus 2.5 % ; p<0.001 ) , an increase in heart rate ( 78.3 + /- 7.3 to 82 + /- 7.9 bpm ; p=0.02 ) , and a reduction in the left ventricular mass/height index ( 105 + /- 29.3 versus 96.6 + /- 28.58 g/m ; p=0.002 ) . Both groups showed similar increases in the levels of alkaline phosphatase and comparable adjustments in antihypertensive therapy ; blood pressure , however , did not change . CONCLUSION The use of sibutramine caused weight loss and a reduction in left ventricular mass in obese and hypertensive patients with no interference with blood pressure or with antihypertensive therapy The Trial of Antihypertensive Interventions and Management was a multicenter r and omized , placebo-controlled  trial design ed to assess the effectiveness of various combinations of pharmacologic and dietary interventions in the treatment of mild hypertension ( diastolic blood pressure 90 - 100 mmHg ) . The primary outcome was blood pressure change between baseline and 6 months . The study consisted of a 3 X 3 factorial design wherein participants were r and omly allocated to  nine drug-diet treatment groups . Drugs included placebo , diuretic , and beta-blocker . Diets were usual , weight loss , and low sodium/high potassium . The basic strategy was to address clinical questions of interest by comparing mean blood pressure changes of selected drug-diet combinations . This paper describes the study including experimental design , sample size considerations , statistical analysis , organizational structure , and baseline findings BACKGROUND Although it is known that plasma leptin concentrations correlate with the amount of adipose tissue in the body , little information is available on the long-term effects on leptin concentrations of changes in diet and exercise . OBJECTIVE We wanted to examine whether changes in dietary energy sources and exercise-mediated energy expenditure , alone or in combination , affect plasma leptin concentrations . DESIGN In a r and omized , 2 x 2 factorial trial , 186 men with metabolic syndrome were divided into 4 groups : diet , exercise , a combination of diet and exercise , and control . Data on dietary intake , physical fitness , and demographics were collected and plasma leptin concentrations were measured before and after a 1-y intervention period . RESULTS Plasma leptin concentrations , body mass index , and fat mass decreased in association with long-term reductions in food intake as well as increased physical activity . By adjusting for either body mass index or fat mass , we observed a highly significant reduction in plasma leptin concentration after both the diet and the exercise interventions . There was no interaction between the interventions , suggesting a direct and additive effect of changes in diet and physical activity on plasma leptin concentrations . CONCLUSION Long-term changes in lifestyle consisting of decreased intake of dietary fat and increased physical activity reduced plasma leptin concentrations in humans beyond the reduction expected as a result of changes in fat mass Aim : The aim of our study was to comparatively evaluate the efficacy and safety of orlistat and sibutramine treatment in obese hypertensive patients , with a specific attention to cardiovascular effects and to side effects because of this treatment BACKGROUND In animal models , cannabinoid-1 receptor ( CB1 ) blockade produces a lean phenotype , with resistance to diet-induced obesity and associated dyslipidaemia . We assessed the effect of rimonabant , a selective CB1 blocker , on bodyweight and cardiovascular risk factors in overweight or obese patients . METHODS patients with body-mass index 30 kg/m2 or greater , or body-mass index greater than 27 kg/m2 with treated or untreated dyslipidaemia , hypertension , or both , were r and omised to receive double-blind treatment with placebo , 5 mg rimonabant , or 20 mg rimonabant once daily in addition to a mild hypocaloric diet ( 600 kcal/day deficit ) . The primary efficacy endpoint was weight change from baseline after 1 year of treatment in the intention-to-treat population . FINDINGS Weight loss at 1 year was significantly greater in patients treated with rimonabant 5 mg ( mean -3.4 kg [ SD 5.7 ] ; p=0.002 vs placebo ) and 20 mg ( -6.6 kg [ 7.2 ] ; p<0.001 vs placebo ) compared with placebo ( -1.8 kg [ 6.4 ] ) . Significantly more patients treated with rimonabant 20 mg than placebo achieved weight loss of 5 % or greater ( p<0.001 ) and 10 % or greater ( p<0.001 ) . Rimonabant 20 mg produced significantly greater improvements than placebo in waist circumference , HDL-cholesterol , triglycerides , and insulin resistance , and prevalence of the metabolic syndrome . The effects of rimonabant 5 mg were of less clinical significance . Rimonabant was generally well tolerated with mild and transient side effects . INTERPRETATION CB1 blockade with rimonabant 20 mg , combined with a hypocaloric diet over 1 year , promoted significant decrease of bodyweight and waist circumference , and improvement in cardiovascular risk factors A group of previously untreated obese hypertensive patients were started on a weight reduction programme supervised by two dietitians working in a general practice surgery . It was stressed from the beginning of the programme that reducing blood pressure was the purpose of the diet . The results of follow-up after six months are presented together with results for a control group of obese hypertensive patients not receiving dietary advice or drug therapy , but being followed by the general practitioner . The weight , systolic blood pressure and diastolic blood pressure of the dieting hypertensive group were significantly lower than those of the non-dieting group after six months . However , the drop-out rate was significantly higher for the dieting group than for the non-dieting group . The results of a separate comparison between a control group of obese normotensive patients following the same dietary programme and the group of dieting obese hypertensive patients are also presented . Attendance rates and weight loss achieved were significantly better for the hypertensive group than for the normotensive group after 12 months . Weight reduction appears to be an effective first-line therapy for approximately 50 % of obese patients with mild to moderate hypertension , and raised blood pressure appears to provide motivation for such patients to attend a dietitian 's clinic and to lose weight BACKGROUND Few trials have evaluated the effects of reduced sodium intake in older individuals , and no trial has examined the effects in relevant subgroups such as African Americans . PATIENTS AND METHODS The effects of sodium reduction on blood pressure ( BP ) and hypertension control were evaluated in 681 patients with hypertension , aged 60 to 80 years , r and omly assigned to a reduced sodium intervention or control group .  Participants ( 47 % women , 23 % African Americans ) had systolic BP less than 145 mm Hg and diastolic BP less than 85 mm Hg while taking 1 antihypertensive medication . Three months after the start of intervention , medication was withdrawn . The primary end point was occurrence of an average systolic BP of 150 mm Hg or more , an average diastolic BP of 90 mm Hg or more , the resumption of medication , or a cardiovascular event during follow-up ( mean , 27.8 months ) . RESULTS Compared with control , mean urinary sodium excretion was 40 mmol/d less in the reduced sodium intervention group ( P<.001 ) ; significant reductions in sodium excretion occurred in subgroups defined by sex , race , age , and obesity . Prior to medication withdrawal , mean reductions in systolic and diastolic BPs from the reduced sodium intervention , net of control , were 4.3 mm Hg ( P<.001 ) and 2.0 mm Hg ( P = .001 ) . During follow-up , an end point occurred in 59 % of reduced sodium and 73 % of control group participants ( relative hazard ratio = 0.68 , P<.001 ) . In African Americans , the corresponding relative hazard ratio was 0.56 ( P = .005 ) ; results were similar in other subgroups . In dose-response analyses , end points were progressively less frequent with greater sodium reduction ( P for trend = .002 ) . CONCLUSION A reduced sodium intake is a broadly effective , nonpharmacologic therapy that can lower BP and control hypertension in older individuals This 6-month r and omized study evaluated the safety and efficacy of sibutramine in 57 overweight Hispanic patients with hypertension . Following a 2-week washout to confirm the diagnosis of hypertension , antihypertensive medication was adjusted to achieve a blood pressure less than 140/90 mm Hg before institution of either sibutramine 10 mg or placebo once a day . A body mass index in excess of 27 kg/m2 was required for entry . At study end , weight had changed from 75.4±9.6 to 70.0±9.5 kg in the sibutramine group and from 77.9±9.0 to 74.5±9.4 kg in the placebo group . In the sibutramine  group , systolic blood pressure was 127.8±5.8 mm Hg after stabilization and 125.2±8.5 mm Hg after completion of the trial ; respective values for diastolic blood pressure were 82.4±3.7 and 81.5±4.6 mm Hg . With placebo  , blood pressure dropped from 129.0±7.1/80.9±4.9 mm Hg to 122.8±9.7/80.3±5.4 mm Hg at the same timepoints . In the sibutramine group , 14 patients reported 21 adverse events , most frequently headache ( n=5 ) , constipation ( n=4 ) , and dry mouth ( n=4 ) . In the placebo group , 13 patients had 20 adverse events . Sibutramine is safe and effective in overweight Hispanic patients with hypertension , but monitoring of blood pressure and titration of antihypertensive medication are necessary OBJECTIVE Plasma renin activity was measured at baseline and 6 months in a trial of nonpharmacologic therapy of mild hypertension to determine whether plasma renin activity predicts the diastolic blood pressure ( DBP ) response to nonpharmacologic therapy . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial of volunteers from the general community with mild hypertension ( DBP between 90 and 100 mm Hg ) , off all antihypertensive therapy at baseline , treated in special research clinics ( n = 593 ) . INTERVENTIONS Subjects were r and omly assigned to usual , weight loss , or low sodium/high potassium diet and then r and omly assigned to receive placebo , chlorthalidone , or atenolol . MAIN OUTCOME MEASURES Renin was analyzed as plasma renin activity and as a renin index ( logarithm of 24-hour urinary sodium excretion times logarithm of plasma renin activity ) ( 593 patients at baseline and 6 months ) to correct for varied sodium intakes . The DBP was measured using the r and om zero device . RESULTS Change in DBP at 6 months could be predicted from baseline plasma renin activity or renin index . The DBP was decreased after 6 months of therapy by 2 mm Hg for each unit increase in baseline plasma renin activity and by 0.16 mm Hg for each unit increase in baseline renin index . Patients in the highest renin index quartile had a greater DBP response to atenolol therapy , and patients in the lowest renin index quartile had a greater DBP response to chlorthalidone therapy . Weight loss diet achieved a greater reduction in DBP in patients with higher baseline renin index and had an additive effect on DBP response in both of the drug groups . Patients on a weight loss diet receiving placebo in the highest baseline renin index quartile had a reduction in DBP of 12.4 mm Hg , compared with 4.4 mm Hg in the lowest baseline renin index quartile ( P = .009 ) . A low sodium/high potassium diet had a lesser effect than a weight loss diet on pharmacologic therapy . As with the weight loss diet , patients on a low sodium/high potassium diet in the highest baseline renin index quartile had a greater reduction in DBP than patients in the lowest baseline renin index quartile . CONCLUSIONS These data suggest a significant relationship between baseline levels of plasma renin index and the likelihood of success of nonpharmacologic treatment of hypertension OBJECTIVES To examine the effect of diet and exercise-induced weight loss on bone mineral density in overweight postmenopausal women DESIGN A 1-year prospect i ve , r and omized clinical trial . SETTING Two university medical school research centers . PARTICIPANTS Sixty-seven overweight postmenopausal women , a subset of the women who participated 
    Output:
    
In patients with essential hypertension , therapy with a weight loss diet or orlistat result ed in reductions in body weight and BP .
Although sibutramine treatment reduced body weight , it did not lower BP