***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: This study investigated the differences in the effect of an angiotensin converting enzyme inhibitor ( ACEI ) compared with an angiotensin receptor blocker ( ARB ) on blood pressure ( BP ) and pulse pressure ( PP ) measured in the clinic ( CBP and CPP , respectively ) , at home ( HBP , HPP ) and with ambulatory monitoring ( ABP , APP ) . Twenty-seven hypertensive patients were r and omised to receive lisinopril ( 20 mg ) or losartan ( 50 mg ) for 5 weeks , and were subsequently crossed-over to the alternative treatment for a second 5-week period . Measurements of CBP , 24-h ABP and 5-days HBP were performed before r and omisation and at the end of each treatment period . All measurement methods showed that lisinopril was more effective than losartan in reducing BP . However , the difference between the two drugs was demonstrated with greater precision using HBP ( P<0.001 ) than 24-h ABP ( P<0.01 ) , whereas the poorest precision for demonstrating this difference was provided by CBP ( P<0.05 ) . Lisinopril was also found more effective than losartan in reducing HPP ( P=0.01 ) and 24-h APP ( P=0.03 ) whereas no such a difference was detected using measurements of CPP . It was concluded that the antihypertensive drugs may differ in their effects not only on BP , but also on PP . HBP monitoring appears to be as reliable as 24-h ABP monitoring in detecting differences in the effect of drugs on both BP and PP . Clinic measurements seem to be the least reliable method , particularly in the detection of differences in PP Office , home , and ambulatory blood pressure ( BP ) demonstrate variable associations with outcomes . The authors sought to compare office BP ( OBP ) , home BP ( HBP ) , and ambulatory BP ( ABP ) for measuring responses to hydrochlorothiazide ( HCTZ ) , atenolol , and their combination . After completing washout , eligible patients were r and omized to atenolol 50 mg or HCTZ 12.5 mg daily . Doses were doubled after 3 weeks and the alternate drug was added after 6 weeks if BP was > 120/70 mm Hg ( chosen to allow maximum opportunity to assess genetic associations with dual BP therapy in the parent study ) .  OBP  ( in triplicate ) ,  HBP  ( twice daily for 5 days ) , and 24-hour ABP  were measured at baseline , after monotherapy , and after combination therapy . BP responses were compared between OBP , HBP , and ABP for each monotherapy and combination therapy . In 418 patients , OBP overestimated BP response compared with HBP , with an average 4.6 mm Hg greater reduction in systolic BP ( P<.0001 ) and 2.1 mm Hg greater reduction in diastolic BP ( P<.0001 ) across all therapies . Results were similar for  atenolol  and  HCTZ monotherapy . ABP response was more highly correlated with HBP response ( r=0.58 ) than with OBP response ( r=0.47 ; P=.04 ) . In the context of a r and omized clinical trial , the authors have identified significant differences in HBP , OBP , and ABP methods of measuring BP response to atenolol and HCTZ monotherapy It is still uncertain whether one can safely base treatment decisions on self-measurement of blood pressure . In the present study , we investigated whether antihypertensive treatment based on self-measurement of blood pressure leads to the use of less medication without the loss of blood pressure control . We r and omly assigned 430 hypertensive patients to receive treatment either on the basis of self-measured pressures ( n=216 ) or office pressures ( OPs ; n=214 ) . During 1-year follow-up , blood pressure was measured by office measurement ( 10 visits ) , ambulatory monitoring ( start and end ) , and self-measurement ( 8 times , self-pressure group only ) . In addition , drug use , associated costs , and degree of target organ damage ( echocardiography and microalbuminuria ) were assessed . The self-pressure group used less medication than the OP group ( 1.47 versus 2.48 drug steps ; P<0.001 ) with lower costs ( $ 3222 versus $ 4420 per 100 patients per month ; P<0.001 ) but without significant differences in systolic and diastolic OP values ( 1.6/1.0 mm Hg ; P=0.25/0.20 ) , in changes in left ventricular mass index ( -6.5 g/m(2 ) versus -5.6 g/m(2 ) ; P=0.72 ) , or in median urinary microalbumin concentration ( -1.7 versus -1.5 mg per 24 hours ; P=0.87 ) . Nevertheless , 24-hour ambulatory blood pressure values at the end of the trial were higher in the self-pressure than in the OP group : 125.9 versus 123.8 mm Hg ( P<0.05 ) for systolic and 77.2 versus 76.1 mm Hg ( P<0.05 ) for diastolic blood pressure . These data show that self-measurement leads to less medication use than office blood pressure measurement without leading to significant differences in OP values or target organ damage . Ambulatory values , however , remain slightly elevated for the self-pressure group Background Gender , age , smoking , race , and body mass index have been reported to determine the ambulatory white-coat effect ( WCE ) and white-coat hypertension ( WCH ) . Methods Baseline conventional , day-time ambulatory and self-measured home blood pressure measurements from the THOP trial were used to study the effect of gender , age , body mass index , smoking habits and treatment status on the white-coat syndrome as assessed by ambulatory monitoring or self-measurement . Results The mean systolic/diastolic WCE was 9.1/6.7 mmHg if based on ambulatory blood pressure and 12.2/8.7 mmHg if based on self-measured blood pressure . The ambulatory WCE was significantly higher in women , in older subjects ( 65 + ) , in obese subjects , in non-smokers and in patients on antihypertensive drug treatment . The self-measured WCE was significantly higher in women and in non-smokers .  Ambulatory WCH was present in 6.6 % of the untreated patients and 14.2 % had self-measured WCH . The proportion of ambulatory WCH was significantly higher in obese subjects ; the proportion of self-measured WCH did not differ by gender , age , body mass index , or smoking habits . Conclusions The ambulatory white-coat syndrome was determined by gender , age , body mass index , smoking habits , and treatment status . The self-measured white-coat syndrome was greater than the ambulatory white-coat syndrome but depended less on the determinants under study Background —The prevalence and clinical significance of isolated office ( or white coat ) hypertension is controversial , and population data are limited . We studied the prevalence of this condition and its association with echocardiographic left ventricular mass in the general population of the PAMELA ( Pressione Arteriose Monitorate E Loro Associazioni ) Study . Methods and Results —The study involved a large , r and omized sample ( n=3200 ) representative of the Monza ( Milan ) population , 25 to 74 years of age . Participants in the study ( 64 % of the sample ) underwent measurements of office , home , 24-hour ambulatory blood pressure , and echocardiography . Isolated office hypertension was defined as systolic or diastolic values ≥140 mm Hg or ≥90 mm Hg , respectively . Home and ambulatory normotension were defined according to criteria previously established from the PAMELA Study , for example , < 132/83 mm Hg ( systolic/diastolic ) for home and 125/79 mm Hg for 24-hour average blood pressure . Treated hypertensive subjects were excluded from analysis that was made on a total of 1637 subjects . Depending on normotension being established on systolic or diastolic blood pressure measured at home or over 24 hours , the prevalence of isolated office hypertension ranged from 9 % to 12 % . In these subjects , left ventricular mass index was greater ( P < 0.01 ) than in subjects with normotension both in and outside the office . This was the case also for prevalence of left ventricular hypertrophy . Left ventricular mass index and hypertrophy were similarly greater in subjects found to have normal office but elevated home or ambulatory blood pressure ( ≈10 % of the population ) . Conclusions —Isolated office hypertension has a noticeable prevalence in the population and is accompanied by structural cardiac alterations , suggesting that it is not an entirely harmless phenomenon . This is the case also for the opposite condition , that is , normal office but elevated home or ambulatory blood pressure , which implies that limiting blood pressure measurements to office values may not suffice in identification of subjects at risk BACKGROUND Our objective was to assess the value of home blood pressure ( BP ) monitoring in comparison to office BP measurements and ambulatory monitoring in predicting hypertension-induced target-organ damage . METHODS Sixty-eight untreated patients with hypertension with at least two routine pre study office visits were included ( mean age , 48.6 + /- 9.1 [ SD ] years ; 50 men ) .  Office BP was measured in two study visits , home BP was measured for 6 workdays , and ambulatory BP was monitored for 24 h. All BP measurements were obtained using vali date d electronic devices . Target-organ damage was assessed by measuring the echocardiographic left-ventricular mass index ( LVMI ) , urinary albumin excretion rate ( AER ) in two overnight urine collection s , and carotid-femoral pulse-wave velocity ( PWV ) ( Complior device ; Colson , Garges-les-Gonesse , Paris , France ) . RESULTS The correlation coefficients of LVMI with office BP were 0.24/0.15 ( systolic/diastolic ) , with home BP 0.35/0.21 ( systolic , P < .01 ) , and with 24-h ambulatory BP 0.23/0.19 , awake 0.21/0.16 , and asleep 0.28/0.26 ( asleep , both P < .05 ) . The correlation coefficients of AER with office BP were 0.24/0.31 ( diastolic , P < .05 ) , with home BP 0.28/0.26 ( both P < .05 ) , and with 24-h ambulatory BP 0.25/0.24 , awake 0.24/0.25 ( diastolic , P < .05 ) , and asleep 0.26/0.18 ( systolic , P < .05 ) . There was a trend for negative correlations between PWV and diastolic BP measurements ( not significant ) . In multiple-regression models assessing independent predictors of each of the three indices of target-organ damage , systolic home BP and age were the only independent predictors of increased LVMI that reached borderline statistical significance . CONCLUSIONS These data suggest that home BP is as reliable as ambulatory monitoring in predicting hypertension-induced target-organ damage , and is superior to carefully taken office measurements BACKGROUND Because of poor patient compliance and clinical inertia , hypertension control rates remain poor . Home blood-pressure measurements ( HBPM ) improve compliance of patients and achievement of blood pressure ( BP ) targets . However , few studies have evaluated self-BP management by patients . METHODS In a multicenter , prospect i ve , single-group , open-label pilot study of 111 patients whose hypertension was uncontrolled despite monotherapy , we studied satisfaction with , and feasibility of , HBPM and self-titration of antihypertensive treatment using telemedicine for compliance , efficacy , and safety . After education ( protocol , action plan , and use of the HBPM device ) , patients performed a sequence of HBPM every 2 weeks for 8 weeks . Following a stepwise approach , treatment was increased by the patient at weeks 4 and 6 if average HBPM values exceeded predefined limits . For each titration , the patient informed the Core Center by telemedicine , but BP values were transferred automatically . RESULTS Overall , 80 % of patients were satisfied ( 58 % ) or very satisfied ( 23 % ) with the program ( 95 % confidence interval , 73 % to 87 % ) . Regarding compliance , 78 % of patients fully complied with self-measurement , and just over 71 % titrated their treatment adequately . Physicians were satisfied ( 52 % ) or very satisfied ( 22 % ) with the program . Between the first and final visits ( at week 8) , office systolic/diastolic BP ( mean + /- SD ) decreased significantly from 151 + /- 9/91 + /- 6 to 143 + /- 13/84 + /- 11 mmHg . During the trial ,  HBPM  ( mean + /- SD ) decreased significantly from 149 + /- 13/86 + /- 12 to 138 + /- 16/81 + /- 10 mmHg . No significant safety issues were reported . CONCLUSIONS This innovative approach to the management of hypertension , combining self-measurement and self-titration , is feasible , well-accepted by both patients and physicians , and safe BACKGROUND Home blood pressure ( BP ) 
    Output:
    
The studies review ed consistently showed moderate diagnostic agreement between HBPM and ABPM , and superiority of HBPM compared to office measurements in diagnosing uncontrolled hypertension , assessing antihypertensive drug effects and improving patients ' compliance and hypertension control .
Preliminary evidence suggests that HBPM has the potential for cost savings .
CONCLUSIONS There is conclusive evidence that HBPM is useful for the initial diagnosis and the long-term follow-up of treated hypertension .