***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: The efficacy of self-recording of blood pressure in the management of hypertension was assessed in a r and omized clinical trial involving 140 persons who had been receiving antihypertensive therapy for a year or more , but whose diastolic blood pressure had remained at 95 mm Hg or higher . To control for the increased attention implicit in self-recording , which might affect blood pressure , the patients were assigned at r and om to one of the four groups : self-recording and monthly home visits , self-recording only , monthly home visits only , and neither self-recording nor monthly home visits . This design also permitted assessment of the effect of home visits . During the 6-month experiment no significant differences were apparent between the groups in either compliance or diastolic blood pressure . However , both self-recording and monthly home visits produced a reduction in blood pressure among patients who admitted to difficulty remembering to take their pills ; a reduction was not seen among patients who said they had no such difficulty . This confirmed an earlier observation suggesting that this easily identified group of patients may be the most responsive to intervention programs Abstract . Objectives : To compare compliance with an antihypertensive treatment administered either twice daily or three times daily . The two formulations of the antihypertensive treatment used ( nicardipine ) “ regular tablets ” ( t.d . ) and “ slow release tablets ” ( b.d . ) are bioequivalent at the daily dosage used in the study . Study design : Open , controlled , parallel design ed study with central ised , r and omised allocation to the treatment groups : TID group : A nicardipine 20 mg tablet , three times daily for 3 months . BID group : A capsule of slow release ( SR ) nicardipine , 50 mg twice daily for 3 months . Patients : 7274 hypertensive patients were investigated by 2.651 general practitioners .  Compliance with the nicardipine was assessed by means of st and ardised interviews with the patients and by a question naire for the investigators . Results : Compliance was slightly higher in the BID than in the TID group ; 71.2 % and 24.5 % of patients in the first group declared their compliance was 100 % and 80 % compared to 82.3 % and 15 % in the second group . A statistically significant relationship was shown between compliance with nicardipine  and the decrease in blood pressure after three months of therapy . However , no significant difference was noticed between the two groups of patients in the absolute decrease in blood pressure after the treatment period : 25.7/14.7 mm Hg in the TID group compared with 25.9/15.0 mm Hg in the BID group . Conclusions : A difference in compliance between the bioequivalent BID and TID formulations of the same active agent was shown in hypertensive patients . However , the difference was not large enough to lead to a difference either in the number of controlled patients or in the decrease in blood pressure . Reducing the number of daily doses does not automatically lead to greater efficacy of treatment Address correspondence to : L.D. Saunders , Department of Health Services Administration and Community Medicine , 13 - 103 Clinical Sciences Building , University of Alberta , Edmonton , Alberta Canada T6 G 2G3 among patients attending a primary health care ( PHC ) clinic in Soweto for antihypertensive drug therapy .  In a 1-year follow-up study of an inception cohort of newly treated hypertensives , only 27 % were compliant ( defined as attending frequently enough to receive 80 % or more of their required treatment ) , 42 % were not seen after the first 3 months ( early dropouts ) , and 22 % continued to attend until the last 3 The effects of metoprolol ( Betaloc tablets ) in a group of 193 hypertensives were compared with the effects of a slow-release formulation ( Betaloc Durules ) in a further group of 196 patients . Patients were selected at r and om for treatment . There were no differences between the groups in terms of age , weight , sex , blood pressure , concurrent illness or concomitant therapy . Blood pressure control and apparent adverse effects were similar for both groups ; the overall withdrawal rate from each group was similar . Compliance , assessed by tablet counts , was significantly improved in the group receiving once-daily therapy . Simplification of the dosage regimen to once-daily therapy appears to improve the patient 's willingness to comply with the physician 's instructions A multifactorial health-education program design ed to enhance compliance with a once-daily regimen of atenolol was evaluated among 453 patients enrolled in health maintenance organizations ( HMOs ) . The initiation of the 180-day study period was used to classify patients as either new or existing cases of hypertension . In turn , patients in these two categories were r and omly assigned to a control or an experimental group . Patients assigned to the experimental groups received an enrollment kit upon exercising their initial prescription ( new patients ) or their first refill request ( existing patients ) . The kit contained : a 30-day supply of atenolol ; an educational newsletter about hypertension ; information on nutrition and life-style changes ; and an explanation of the intent and content of the program . Before the next scheduled prescription-refill date , each patient was contacted by telephone to inquire about his or her experience with the therapy and to stress the importance of adherence to the regimen . Each month thereafter , the newsletter and an enclosed prescription-refill reminder were mailed to each patient . The medication possession ratio , defined as the number of days ' supply of atenolol  obtained by a patient during the 180-day study period , was significantly ( P less than or equal to 0.001 ) enhanced for the new and existing experimental groups relative to the control groups . Multiple regression analyses revealed that enrollment in the health-education program increased the number of days ' supply of atenolol obtained by existing patients by 27 ( P less than or equal to 0.001 ) , and by new patients by 40 ( P less than or equal to 0.001 ) Low rates of adherence to hypertensive therapy  limit patients ' securing the full benefits of treatment . While some factors related to adherence have been identified , research on the effectiveness of interventions to increase adherence levels is sparse . The present study was design ed to assess the impact of a series of different interventions on a group of some 400 patients , all under the care of private physicians in a small community . A factorial design was employed to deliver four , sequential educational interventions , about four months apart , to r and omly selected sub-groups . Interviews before and after each intervention provided information concerning self-reported adherence , health status , health beliefs , and personal characteristics . Pertinent medical records and pharmacy data were also obtained . The first intervention — printed material —did not significantly affect adherence . The second and fourth interventions —nurse telephone calls and social support — each increased medication taking and the third intervention — self-monitoring — led to better weight control . There was no cumulative impact of the interventions and different aspects of regimens were not signiticantly related to one another In this r and omized controlled trial , the value of using occupational health nurses ( OHNs ) to monitor the care of hypertensive employees at work was compared with regular care ( RC ) delivered in the community . One year after entry , the blood pressure level , medication history , compliance with treatment , and cost of hypertensive care of the participants were determined by independent evaluators . The reduction in diastolic blood pressure ( DBP ) , the measure of effectiveness , was 10.5 + /- 1.1 mm Hg ( mean + /- SEM ) in the OHN group and 7.7 + /- 1.1 mm Hg in the RC group , and the proportion under good blood pressure control was 41.8 % and 31.0 % respectively . These between-group differences were not statistically significant . Although the employees in the OHN group were more medicated and had a lower treatment dropout rate , neither difference was statistically significant . In addition , the proportion of employees who were compliant with prescribed medication was virtually identical in both groups . The cost of the care received by employees in the OHN group of $ 404.14 for the year was substantially higher than that of $ 250.15 in the RC group with the difference principally related to the cost of visiting the OHNs and a significant difference in drug cost ( p less than 0.006 ) . The incremental cost-effectiveness ( C/E ) ratio of $ 53.67 per mm Hg DBP reduction per year for onsite blood pressure monitoring was higher than the base C/E ratio of $ 32.65 per mm Hg for regular care . Our findings indicate that monitoring the blood pressure of hypertensive employees at work is neither clinical ly effective nor cost-effective . ( ABSTRACT TRUNCATED AT 250 WORDS Poor compliance is a principal cause of treatment failure in hypertensive patients . Once-daily dosing improves compliance , but 24-h antihypertensive activity should be provided . The compliance , efficacy , and safety of amlodipine and nifedipine slow-release ( SR ) were compared in patients with mild-to-moderate essential hypertension recruited among 24 centers in France . After a 2-week washout period , 103 patients were r and omized to 12 weeks of 5 to 10 amlodipine mg once daily ( n = 55 ) or 20 mg nifedipine SR twice daily ( n = 48 ) . Compliance was calculated by electronic drug monitoring . Efficacy was measured by ambulatory and casual BP recordings . Patients receiving amlodipine demonstrated better compliance than patients receiving nifedipine SR with respect to compliance index ( the total number of doses taken divided by the total number of doses prescribed , expressed as a percentage ; 98.3 % v 87 % ; P < .0001 ) , days on which the correct number of doses were taken ( 92.5 % v 74.8 % ; P < .0001 ) , and prescribed doses taken on schedule ( 88.7 % v 71.6 % ; P < .0001 ) . Absolute and relative therapeutic coverage were higher in patients receiving amlodipine than nifedipine SR ( P < .0001 ) . Mean SBP and DBP decreased equally in both groups , although amlodipine offered better BP control compared with nifedipine SR at specific times of day . Fewer patients had high nocturnal SBP with amlodipine ( 39.3 % ) than nifedipine SR ( 71.4 % ; P = .042 ) . Adverse events and treatment withdrawals occurred less frequently in amlodipine-treated patients than in nifedipine SR-treated patients . Amlodipine ( 5 to 10 mg ) once daily provides improved compliance , better 24-h BP control , and fewer adverse events than 20 mg nifedipine SR twice daily in patients with mild-to-moderate hypertension A controlled , r and omized study was conducted in two chain pharmacies to determine the clinical value of comprehensive pharmacy services for hypertensive patients in a chain pharmacy setting . Twenty-seven patients were enrolled as intervention participants with 26 control subjects . Monthly services for the intervention group included blood pressure and heart rate assessment s and counseling on lifestyle modifications and drug therapy . Control patients received initial and final blood pressure measurements and minimal counseling . Both study and control groups completed quality -of-life question naires upon entering and completing the study . Results showed that blood pressure control was significantly improved in the study group . Compliance rates as well as energy/fatigue scores ( a quality -of-life scale ) improved in the study group compared with the control population . Community pharmacists in chain stores could have a beneficial effect on the health care of large numbers of patients if pharmaceutical care programs were developed This article reports a r and omized controlled trial design ed to test the effects of special packaging of antihypertensive medication on compliance and blood pressure control . One hundred eighty subjects who had exhibited elevated blood pressure greater than 90 mmHg in the two years prior to the study were recruited from patients receiving care at a community hospital-based family medicine practice . After completing preenrollment interviews and blood pressure measurements , subjects were r and omly assigned to receive their antihypertensive medications either in the usual vials or in special unit dose-reminder packaging . Follow-up interviews  , pill counts , and blood pressure measurements were performed at three-month intervals . There were no statistically significant differences between the control and experimental groups with regard to age , sex , race , employment , education , marital status , insurance coverage , or blood pressure regimens . Prior to the intervention , the experimental group had slightly lower diastolic blood pressure and reported better compliance than the control group . Analyses performed on 165 subjects completing the first follow-up visit revealed no significant improvements in blood pressure control or compliance for patients receiving special medication packaging . While some patients found it easy to remember to take pills packaged using this format , they also found the packages somewhat more difficult and inconvenient to use . In contrast to previously reported work , this study did not demonstrate any significant improvement in compliance with special packaging of antihypertensive medications This double-blind , double-dummy , r and omized clinical trial , conducted in elderly patients with mild hypertension , compared adherence to treatment , efficacy , side effects , and quality of life during treatment with transdermal clonidine versus oral sustained-release verapamil ( verapamil-SR ) .  Blood pressure declined significantly -- from 148/95 mm Hg at baseline to 139/84 after titration and 135/86 after maintenance -- with transdermal clonidine ( n = 29 ) , and from 156/96 to 144/85 and 148/88 , respectively , with verapamil-SR ( n = 29 ) . Adverse event rates and quality -of-life question naire responses were similar in the two treatment groups . Transdermal clonidine was worn as directed during more than 96 % of patient-weeks of treatment . Compliance with the oral verapamil regimen was less consistent : Ver 
    Output:
    
Reducing the number of daily doses appears to be effective in increasing adherence to blood pressure-lowering medication and should be tried as a first-line strategy , although there is so far less evidence of an effect on blood pressure reduction .