***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: We compared the reproducibility over time of blood pressure measured at the health examinations ( screening blood pressure ) and blood pressure measured at home ( home blood pressure ) . Both screening and home blood pressure were measured in subjects of a rural community . Subjects measured their own blood pressure at home once in the morning using a semiautomatic oscillometric blood pressure measuring device at least three times ( on at least 3 days ) in each of two 4-week periods separated by one year . Similarly , two screening blood pressure measurements were obtained from the subjects at each of two health examinations also taken 1 year apart . A total of 136 untreated subjects without cardiovascular complications ( 40 men and 96 women , 56 + /- 11.7 years , mean + /- SD ) were analyzed in the study . The correlations between the first and second blood pressure measurements of the subjects were significantly higher for the home blood  pressure  measurements ( systolic : r = 0.844 and diastolic : r = 0.830 ) than for the screening blood pressure measurements ( systolic : r = 0.692 and diastolic : r = 0.570 ) . The mean differences between the first and second home blood pressure ( 0.8 + /- 7.7 mm Hg for systolic BP and 0.9 + /- 5.5 mm Hg for diastolic BP ) were significantly smaller than those for the screening blood pressure ( -3.9 + /- 13.8 for systolic BP and -3.1 + /- 10.2 for diastolic BP ) ( P < .001 for both comparisons ) , suggesting that the reproducibility of home blood pressure over time is superior to that of screening blood pressure . Such reliable blood pressure measurements obtained at home have a clinical significance for the diagnosis and treatment of hypertension and as a tool for evaluating the efficacy of antihypertensive drugs . Home blood pressure measurements also may be more useful than screening blood pressure measurements in predicting future cardiovascular events Abstract Objective : To assess whether recording of ambulatory blood pressure at night causes arousal from sleep and a change in the continuous blood pressure recorded simultaneously . Design : Repeated measurement of blood pressure with two ambulatory blood pressure machines ( Oxford Medical ABP and A&D TM2420 ) during continuous measurement of beat to beat blood pressure and continuous electroencephalography . Setting : Sleep reseach laboratory . Subjects -- Six normal subjects . Main outcome measures : The duration of electroencephalographic arousal and the beat to beat changes in blood pressure produced by the measurement of  ambulatory blood pressure ; the size of any changes that this arousal and change in blood pressure produced in the blood pressure recorded by the ambulatory machine . Results : Both ambulatory blood pressure machines caused arousal from sleep : the mean duration of arousal was 16 seconds ( 95 % range 0 - 202 ) with the ABP and 8 seconds ( 0 - 73 ) with the TM2420 . Both also caused a rise in beat to beat blood pressure . During non-rapid eye movement sleep , this rise led to the ABP machine overestimating the true systolic blood pressure during sleep by a mean of 10 ( SD 14.8 ) mm Hg and the TM2420 by a mean of 6.3 ( 8.2 ) mm Hg . On average , diastolic pressure was not changed , but measurements in individual subjects changed by up to 23 mm Hg . These changes varied in size among subjects and stages of sleep and were seen after measurements that did not cause any electroencephalographic arousal . Conclusions : Ambulatory blood pressure machines cause appreciable arousal from sleep and therefore alter the blood pressure that they are trying to record . This effect should be taken into account when recordings of blood pressure at night are interpreted in clinical work and epidemiological research Objective To compare the predictive powers of self-measurement of blood pressure at home ( home blood pressure measurement ) and casual ( screening ) blood pressure measurement for mortality . Design A prospect i ve cohort study . Subjects and methods We obtained  home and screening blood pressure measurements for 1789 subjects aged ≥ 40 years who were followed up for a mean of 6.6 years . The prognostic significance of blood pressure for mortality was determined by the Cox proportional hazards regression model adjusted for age , sex , smoking status , past history of cardiovascular disease , and the use of antihypertensive medication . Results When the home blood pressure values and the screening blood pressure values were simultaneously incorporated into the Cox model as continuous variables , only the average of multiple ( taken more than three times ) home systolic blood pressure values was significantly and strongly related to the cardiovascular mortality risk . The average of the two initial home blood pressure values was also better related to the mortality risk than were the screening blood pressure values . Conclusions Home blood pressure measurement had a stronger predictive power for mortality than did screening blood pressure measurement for a general population . This appears to be the first study in which the prognostic significance s of home and screening blood pressure measurements have been compared BACKGROUND Nocturnal blood pressure ( BP ) is an independent risk factor of cardiovascular events . The NOCTURNE study , a multicenter , r and omized controlled trial ( RCT ) using our recently developed information and communication technology ( ICT ) nocturnal home BP monitoring ( HBPM ) device , was performed to compare the nocturnal HBP-lowering effects of differential ARB-based combination therapies in 411 Japanese patients with nocturnal hypertension ( HT ) . Methods and Results : Patients with nocturnal BP ≥120/70 mmHg at baseline even under ARB therapy ( 100 mg irbesartan daily ) were enrolled . The ARB/CCB combination therapy ( irbesartan 100 mg+amlodipine 5 mg ) achieved a significantly greater reduction in nocturnal home systolic BP ( primary endpoint ) than the ARB/diuretic combination ( daily irbesartan 100 mg+trichlormethiazide 1 mg ) ( -14.4 vs. -10.5 mmHg , P<0.0001 ) , independently of urinary sodium excretion and /or nocturnal BP dipping status . However , the change in nocturnal home systolic BP was comparable among the post-hoc subgroups with higher salt sensitivity ( diabetes , chronic kidney disease , and elderly patients ) . CONCLUSIONS This is the first RCT demonstrating the feasibility of clinical assessment of nocturnal BP by ICT-nocturnal HBPM . The ARB/CCB combination was shown to be superior to ARB/diuretic in patients with uncontrolled nocturnal HT independently of sodium intake , despite the similar impact of the 2 combinations in patients with higher salt sensitivity Previous studies of the reproducibility of  blood pressure ( BP ) dipping  have yielded inconsistent results . Few have examined factors that may influence day-to-day differences in dipping .  Ambulatory BP monitoring was performed on three occasions , approximately 1 week apart , in 115 untreated adult subjects with elevated clinic BPs .  The mean ± st and ard deviation BP dip was 18 ± 7/15 ± 5 mm Hg ( sleep/awake BP ratio = 0.87 ± 0.05/0.82 ± 0.06 ) , with a median ( interquartile range ) day-to-day variation of 5.2 (3.1 - 8.1)/4.3 ( 2.8 - 5.6 ) mm Hg . There was no decrease in variability with successive measurements . The reproducibility coefficient ( 5.6 [ 95 % confidence interval , 5.1 - 6.1 ] mm Hg ) was greater and the intraclass correlation coefficient ( 0.53 [ 95 % confidence interval , 0.42 - 0.63 ] ) was smaller for the systolic dip than for 24-hour or awake systolic BPs , suggesting greater day-to-day variability in dipping . Variability in systolic dipping was greater in subjects with higher awake BP , but was not related to age , gender , race , or body mass index . Within individuals , day-to-day variations in dipping were related to variations in the fragmentation index ( P < .001 ) , a measure of sleep quality . Although mean 24-hour and awake BPs were relatively stable over repeated monitoring days , our study confirms substantial variability in BP dipping . Day-to-day differences in dipping are related to sleep quality Hypertension guidelines recommend blood pressure self-measurement at home ( HBP ) , but no previous trial has assessed cardiovascular outcomes in hypertensive patients treated according to HBP . The multicenter Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure ( HOMED-BP ; 2001–2010 ) trial involved 3518 patients ( 50 % women ; mean age 59.6 years ) with an untreated systolic/diastolic HBP of 135–179/85–119 mm Hg . In a 2 × 3 design , patients were r and omized to usual control ( 125–134/80–84 mm Hg ( UC ) ) vs. tight control ( < 125/<80 mm Hg ( TC ) ) of HBP and to initiation of drug treatment with angiotensin converting enzyme inhibitors , angiotensin receptor blockers or calcium channel blockers . During follow-up , a computer algorithm automatically generated treatment recommendations based on HBP . At the last follow-up ( median 5.3 years ) , TC patients used more antihypertensive drugs than UC patients ( 1.82 vs. 1.74 defined daily doses , P=0.045 ) and had a greater HBP reduction ( 21.3/13.1 mm Hg vs. 22.7/13.9 mm Hg , P=0.018/0.020 ) , but they less frequently achieved the lower HBP targets ( 37.4 vs. 63.5 % , P<0.0001 ) . The primary end point , cardiovascular death plus stroke and myocardial infa rct ion , occurred in 25 UC and 26 TC patients ( hazard ratio , 1.02 ; 95 % confidence interval , 0.59–1.77 ; P=0.94 ) . Rates were similar ( P⩾0.13 ) in the three drug groups . In all patients combined , the risk of the primary end point independently increased by 41 % ( 6–89 % ; P=0.019 ) and 47 % ( 15–87 % ; P=0.0020 ) for a 1-s.d . increase in baseline ( 12.5 mm Hg ) and follow-up ( 13.2 mm Hg ) systolic HBP . The 5-year risk was minimal ( ⩽1 % ) if on-treatment systolic HBP was 131.6 mm Hg or less . HOMED-BP proved the feasibility of adjusting antihypertensive drug treatment based on HBP and suggests that a systolic HBP level of 130 mm Hg should be an achievable and safe target Background — Current diagnostic thresholds for ambulatory blood pressure ( ABP ) mainly rely on statistical parameters derived from reference population s. We determined an outcome -driven reference frame for ABP measurement . Methods and Results — We performed 24-hour ABP monitoring in 5682 participants ( mean age 59.0 years ; 43.3 % women ) enrolled in prospect i ve population studies in Copenhagen , Denmark ; Noorderkempen , Belgium ; Ohasama , Japan ; and Uppsala , Sweden . In multivariate analyses , we determined ABP thresholds , which yielded 10-year cardiovascular risks similar to those associated with optimal ( 120/80 mm Hg ) , normal ( 130/85 mm Hg ) , and high ( 140/90 mm Hg ) blood pressure on office measurement . Over 9.7 years ( median ) , 814  cardiovascular end points occurred , including 377 strokes and 435 cardiac events . Systolic/diastolic thresholds for optimal ABP were 116.8/74.2 mm Hg for 24 hours , 121.6/78.9 mm Hg for daytime , and 100.9/65.3 mm Hg for nighttime . Corresponding thresholds for normal ABP were 123.9/76.8 , 129.9/82.6 , and 110.2/68.1 mm Hg , respectively , and those for ambulatory hypertension were 131.0/79.4 , 138.2/86.4 , and 119.5/70.8 mm Hg . After rounding , approximate thresholds for optimal ABP amounted to 115/75 mm Hg for 24 hours , 120/80 mm Hg for daytime , and 100/65 mm Hg for nighttime . Rounded thresholds for normal ABP were 125/75 , 130/85 , and 110/70 mm Hg , respectively , and those for ambulatory hypertension were 130/80 , 140/85 , and 120/70 mm Hg . Conclusions — Population -based outcome -driven thresholds for optimal and normal ABP are lower than those currently proposed by hypertension guidelines Discomfort related to cuff inflation may bias 24 h ambulatory blood pressure ( BP ) measurements , especially during night-time . We accessed the impact of cuff inflations by comparing 24 h BP recorded with a cuff-less tonometric wrist device and an upper-arm oscillometric cuff device .  Fifty-three participants with type 2 diabetes were assigned r and omly to four 24-h BP recordings with 
    Output:
    
Preliminary data suggest that nocturnal home BP measurements yield similar BP values and show good agreement in detecting nondippers when compared with ambulatory BP monitoring .
Thus , nocturnal home BP measurements  might be a reliable and practical alternative to ambulatory BP monitoring to evaluate BP during sleep .
As the use of home BP devices is widespread , well accepted by users and has relatively low cost , it may prove to be more feasible and widely available for routine clinical assessment of nocturnal BP .