***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 
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    Input: CONTEXT Incidence of end-stage renal disease due to hypertension has increased in recent decades , but the optimal strategy for treatment of hypertension to prevent renal failure is unknown , especially among African Americans . OBJECTIVE To compare the effects of an angiotensin-converting enzyme ( ACE ) inhibitor ( ramipril ) , a dihydropyridine calcium channel blocker ( amlodipine ) , and a beta-blocker ( metoprolol ) on hypertensive renal disease progression . DESIGN , SETTING , AND PARTICIPANTS Interim analysis of a r and omized , double-blind , 3 x 2 factorial trial conducted in 1094 African Americans aged 18 to 70 years with hypertensive renal disease ( glomerular filtration rate [ GFR ] of 20 - 65 mL/min per 1.73 m(2 ) ) enrolled between February 1995 and September 1998 . This report compares the ramipril and amlodipine groups following discontinuation of the amlodipine intervention in September 2000 . INTERVENTIONS Participants were r and omly assigned to receive amlodipine , 5 to 10 mg/d ( n = 217 ) , ramipril , 2.5 to 10 mg/d ( n = 436 ) , or metoprolol , 50 to 200 mg/d ( n = 441 ) , with other agents added to achieve 1 of 2 blood pressure goals . MAIN OUTCOME MEASURES The primary outcome measure was the rate of change in GFR ; the main secondary outcome was a composite index of the clinical end points of reduction in GFR of more than 50 % or 25 mL/min per 1.73 m(2 ) , end-stage renal disease , or death . RESULTS Among participants with a urinary protein to creatinine ratio of > 0.22 ( corresponding approximately to proteinuria of more than 300 mg/d ) , the ramipril group had a 36 % ( 2.02 [ SE , 0.74 ] mL/min per 1.73 m(2)/y ) slower mean decline in GFR over 3 years ( P = .006 ) and a 48 % reduced risk of the clinical end points vs the amlodipine group ( 95 % confidence interval [ CI ] , 20%-66 % ) . In the entire cohort , there was no significant difference in mean GFR decline from baseline to 3 years between treatment groups ( P = .38 ) . However , compared with the amlodipine group , after adjustment for baseline covariates the ramipril group had a 38 % reduced risk of clinical end points ( 95 % CI , 13%-56 % ) , a 36 % slower mean decline in GFR after 3 months ( P = .002 ) , and less proteinuria ( P<.001 ) . CONCLUSION Ramipril , compared with amlodipine , retards renal disease progression in patients with hypertensive renal disease and proteinuria and may offer benefit to patients without proteinuria The Losartan Intervention For Endpoint ( LIFE ) reduction in hypertension study is a double-blind , prospect i ve , parallel group study design ed to compare the effects of losartan with those of atenolol on the reduction of cardiovascular morbidity and mortality . A total of 9194 patients with hypertension and ECG left ventricular hypertrophy ( LVH ) by Cornell voltage- duration product and /or Sokolow-Lyon voltage criteria were enrolled in the study , with baseline clinical and ECG data available in 8785 patients ( 54 % women ; mean age , 67±7 years ) . ECG LVH by Cornell voltage- duration product criteria was present in 5791 patients ( 65.9 % ) and by Sokolow-Lyon voltage in 2025 patients ( 23.1 % ) . Compared with patients without ECG LVH by Cornell voltage- duration product criteria , patients with ECG LVH by this method were older ; more obese ; more likely to be female , white , and to have never smoked ; more likely to be diabetic and have angina ; and had slightly higher systolic , diastolic , and pulse blood pressures . In contrast , patients with ECG LVH by Sokolow-Lyon criteria were slightly younger ; less obese ; more likely to be male , black , and current smokers ; less likely to have diabetes ; more likely to have angina and a history of cerebrovascular disease ; and had higher systolic and pulse blood pressure but slightly lower diastolic blood pressure than patients without ECG LVH by this method . By use of multivariate logistic regression analyses , presence of ECG LVH by Cornell voltage- duration product criteria was predominantly associated with higher body mass index , increased age , and female gender , whereas presence of ECG LVH by Sokolow-Lyon voltage criteria was predominantly related to lower body mass index , male gender , and black race . Thus , hypertensive patients who meet Cornell product and Sokolow-Lyon voltage criteria are associated with different , but potentially equally adverse , risk factor profiles A double-blind , positively controlled , forced dose titration study comparing the efficacy and safety of atenolol , captopril , and verapamil sustained release as single agents in the treatment of black patients with mild to moderate hypertension ( diastolic blood pressure , 95 to 114 mm Hg ) was conducted . A total of 394 patients were r and omized to one of the three therapies .  Mean blood pressures during a 2- to 4-week placebo treatment period ( baseline ) ranged from 100.4 to 100.7 mm Hg diastolic and 151.7 to 152.5 mm Hg systolic for the three groups . Of the patients , 355 ( of whom 345 had assessable data ) completed the first treatment period , which consisted of therapy with either 50 mg/d of atenolol , 25 mg every 12 hours of captopril , or 240 mg/d of verapamil sustained release . During the second 4-week treatment period , which 319 patients completed ( 307 assessable ) , half of the patients had their antihypertensive medication increased and the other half continued the same dose . Goal blood pressure was defined as a supine diastolic pressure of less than 90 mm Hg or a 10-mm Hg or greater drop in supine diastolic blood pressure from pretreatment levels . Atenolol , captopril , and verapamil sustained release therapy was associated with goal blood pressure achievement during the first treatment period 55.1 % , 43.8 % , and 65.2 % of the time , respectively , and during the second treatment period 59.6 % , 57.1 % , and 73.0 % of the time . Side effects were minimal and comparable for all three drugs OBJECTIVES We report on a sub analysis of the effects of losartan and atenolol on cardiovascular events in black patients in the Losartan Intervention For Endpoint reduction in hypertension ( LIFE ) study . BACKGROUND The LIFE study compared losartan-based to atenolol-based therapy in 9,193 hypertensive patients with left ventricular hypertrophy ( LVH ) . Overall , the risk of the primary composite end point ( cardiovascular death , stroke , myocardial infa rct ion ) was reduced by 13 % ( p = 0.021 ) with losartan , with similar blood pressure ( BP ) reduction in both treatment groups . There was a suggestion of interaction between ethnic background and treatment ( p = 0.057 ) . METHODS Exploratory analyses were performed that placed LIFE study patients into black ( n = 533 ) and non-black ( n = 8,660 ) categories , overall , and in the U.S. ( African American [ n = 523 ] ; non-black [ n = 1,184 ] ) . RESULTS A significant interaction existed between the dichotomized groups ( black/non-black ) and treatment ( p = 0.005 ) ; a test for qualitative interaction was also significant ( p = 0.016 ) . The hazard ratio  ( losartan relative to atenolol ) for the primary end point favored atenolol in black patients ( 1.666 [ 95 % confidence interval ( CI ) 1.043 to 2.661 ] ; p = 0.033 ) and favored losartan in non-blacks ( 0.829 [ 95 % CI 0.733 to 0.938 ] ; p = 0.003 ) . In black patients , BP reduction was similar in both groups , and regression of electrocardiographic-LVH was greater with losartan . CONCLUSIONS Results of the sub analysis are sufficient to generate the hypothesis that black patients with hypertension and LVH might not respond as favorably to losartan-based treatment as non-black patients with respect to cardiovascular outcomes , and do not support a recommendation for losartan as a first-line treatment for this purpose . The sub analysis is limited by the relatively small number of events BACKGROUND The Dietary Approaches to Stop Hypertension ( DASH ) diet , which emphasizes fruits , vegetables , and low fat dairy products , significantly lowers blood pressure ( BP ) . We conducted a clinical trial to assess the BP response to the DASH diet with an antihypertensive medication , losartan , in participants with essential hypertension . METHODS A total of 55 hypertensive participants were r and omly assigned to 8 weeks of controlled feeding with either a control diet or the DASH diet . Within each diet arm , participants received losartan 50 mg daily or placebo for 4 weeks each , in double blind , r and omized , cross-over fashion . Twenty-four-hour ambulatory BP ( ABP ) was measured at the end of a 2-week run-in period ( baseline ) and after each 4-week intervention period . RESULTS There was no significant change in ABP during the placebo period on the control diet ( n = 28 ) ( -2.3 + /- 1.5/-1.6 + /- 1.0 mm Hg ) , but there was a significant reduction in systolic ABP ( -5.3 + /- 1.5 mm Hg , P < .05 ) and no change in DBP ( -2.5 + /- 1.0 mm Hg ) on the DASH diet ( n = 27 ) . Losartan significantly reduced ABP on the control diet ( -6.7 + /- 1.5/-3.7 + /- 1.0 mm Hg , P < .05 ) and to a greater extent on the DASH diet ( -11.7 + /- 1.5/-6.9 + /- 1.0 mm Hg , P < .05 versus basal and control diet ) particularly in African Americans . On the DASH diet , DeltaSBP on losartan was inversely related to basal plasma renin activity ( n = -0.53 , P = .004 ) . CONCLUSIONS The DASH diet enhances the ABP response to losartan in essential hypertension . This effect is particularly marked in African Americans The antihypertensive effects of penbutolol , a nonselective beta-adrenoceptor antagonist with intrinsic sympathomimetic activity , was assessed in nonobese black South Africans aged 25 to 65 years with uncomplicated mild to moderate essential hypertension . After a 4-week placebo run-in period 50 patients entered a r and omized  placebo-controlled study with a crossover design . For 8 weeks they received a once daily dose of 40 mg penbutolol ( or placebo ) which was increased to 80 mg per day for the next 4 weeks in poor responders . This was followed by a 4-week placebo washout period after which a crossover of treatment was achieved and a second 12-week period of treatment initiated . Thirty-five patients completed the whole study and in 15 patients diastolic blood pressure was reduced below 95 mm Hg . The mean systolic pressures of these patients decreased by 21 mm Hg and their mean diastolic pressure decreased by 11 mm Hg during treatment with penbutolol . These results suggest that penbutolol monotherapy is an alternative therapeutic approach to hypertension in black South Africans 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 OBJECTIVES The purpose of this study was to evaluate the efficacy and tolerability of monotherapy with the selective aldosterone blocker eplerenone in both black and white patients with hypertension . BACKGROUND Essential hypertension and cardiovascular-renal-target organ damage is more prevalent in black than white adults in the U.S. METHODS Black ( n = 348 ) and white ( n = 203 ) patients with mild-to-moderate hypertension were r and omized to double-blind treatment with eplerenone 50 mg , the angiotens 
    Output:
    
With the exception of -blockers for SBP , all the review ed antihypertensive drugs were more effective than placebo in reducing SBP and DBP as continuous measures , although the effect of -blockers on diastolic blood pressure was of marginal significance ( Figures 2 and 3 ) .