***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: To study the impact of diet and exercise and the combination thereof on cardiovascular risk factors , 157 healthy men aged 35 - 60 years ( mean + /- S.D. ; 46.2 + /- 5.0 ) with slightly to moderately raised cardiovascular risk factors , were r and omized to 4 groups , diet ( D , n = 40 ) , exercise ( E , n = 39 ) , diet plus exercise ( DE , n = 39 ) , and no active intervention ( controls ( C , n = 39 ) ) , and investigated at baseline and after 6 months . BMI was significantly reduced in Groups E and DE ( mean difference and 95 % confidence intervals ( CI ) , -0.3 ( -0.5 , -0.01 ) and -0.6 ( -0.9 , -0.3 ) kg/m2 , respectively ) . Waist circumference was reduced in all 3 intervention groups ( D , E , and DE ) , -1.3 ( -2.5 , -0.1 ) , -2.2 ( -3.2 , -1.3 ) and -3.0 ( -3.9 , -2.0 ) cm , but not in the control group . Blood pressure ( BP ) was reduced in all 3 intervention groups , systolic BP 4 - 7 mmHg and diastolic BP 2 - 6 mmHg . Serum cholesterol was reduced in Group DE , -0.45 ( -0.77 , -0.13 ) mmol/l . VLDL-cholesterol was reduced in Groups E and DE , -0.14 ( -0.26 , -0.03 ) and -0.09 ( -0.18 , -0.01 ) mmol/l , whereas LDL-cholesterol was reduced in Groups D and DE -0.30 ( -0.54 , -0.06 ) and -0.35 ( -0.64 , -0.05 ) mmol/l . In contrast , neither HDL-cholesterol nor serum triglycerides were influenced by the interventions . According to the coronary risk profile derived from the Framingham study , all 3 intervention groups ( D , E , and DE ) significantly reduced their estimated 10-year risk ( -13 , -12 , and -14 % , respectively ) . We conclude that even with rather moderate changes in diet and exercise , several important cardiovascular risk factors can be affected and that diet and exercise were about equally effective in reducing cardiovascular risk Objectives Offspring of hypertensive pregnancies have increased cardiovascular risk factors during childhood . We hypothesised that offspring of hypertensive pregnancies would demonstrate increased clinical levels of hypertension by young adult life , which would be proportional to the severity of the pregnancy complication . Design Prospect i ve birth cohort study Setting Tertiary obstetric hospital . Participants 2868 young adult offspring of women enrolled during pregnancy into the Western Australia Pregnancy Cohort ( Raine ) Study . Main outcome measures Cardiovascular risk , including incidence of hypertension and metabolic disease , in those born to hypertensive compared to normotensive pregnancies . Results Young adult offspring of hypertensive pregnancies were 2.5 times ( 95 % CI 1.32 to 4.56 , p=0.004 ) more likely to have global lifetime risk ( QRISK ) scores above the 75th centile . Thirty per cent of 20 year olds with hypertensive blood pressures were born following a hypertensive pregnancy . Pre-eclampsia or hypertension result ing in preterm birth associated with a threefold ( 95 % CI 1.3 to 7.0 , p=0.01 ) greater risk of being hypertensive by age 20 years , with no differences in body mass index . Whereas pregnancy-induced hypertension associated with a smaller 3±1 mm Hg blood pressure rise ( p=0.001 ) and a twofold ( 95 % CI 1.5 to 2.8 , p=0.001 ) greater risk of being obese or overweight . Risk factor associations were consistent throughout early life and independent of other birth-factors . Conclusions Incidence of offspring hypertension was significantly increased in those whose mothers had a more complicated pregnancy history , including preterm birth and pre-eclampsia W.H.O. and U.S. Dept . of Health and Human Services advocate a fat-modified , fruits and vegetable-enriched diet in conjunction with mode-rate physical activity for fitness and health . The Diet and Moderate Exercise Trial ( DAMET ) is a r and omized and controlled study and has provided scientific proof , possibly for the first time , to the above hypothesis ( based on epidemiologic studies , short clinical trials and experimental studies ) that the new approach can cause modulation of risk factors of coronary heart disease ( CHD ) as well as improve fitness . In the DAMET , 231 group A and 232 group B patients with risk factors of CHD were administered a prudent diet for 4 weeks , group A patients in addition were also given at least 400 g/day of fruits and vegetables that are rich in dietary fibre and antioxidants such as vitamins A , C , E , carotene and copper , selenium and magnesium . Fruits and vegetables were administered in a foods-to-eat approach by asking the patients to eat these foods before meals when they were hungry to allow better nutrient adequacy . After 4 weeks , group A patients also did moderate exercise such as brisk walking and spot running compared to no such advice to group B for another 20 weeks . After a follow-up period of 24 weeks , adding exercise to diet was associated with a significant decrease in blood total cholesterol ( 8.9 % ) and LDL-cholesterol ( 6.7 % ) and triglycerides ( 11.9 % ) and a marked increase in HDL-cholesterol ( 16.5 % ) . Mean blood pressures , fasting blood glucose , body weight , body mass index , waist-to-hip ratio and subcutaneous fat also showed a significant decrease in group A , leading to a significant decrease in 12-year CHD risk . A long-term follow-up may be necessary to demonstrate the role of this new approach in decreasing cardiovascular morbidity and mortality BACKGROUND Cumulative blood pressure ( BP ) exposure may adversely influence myocardial function , predisposing individuals to heart failure later in life . OBJECTIVES This study sought to investigate how cumulative exposure to higher BP influences left ventricular ( LV ) function during young to middle adulthood . METHODS The CARDIA ( Coronary Artery Risk Development in Young Adults ) study prospect ively enrolled 5,115 healthy African Americans and whites in 1985 and 1986 ( baseline ) . At the year 25 examination , LV function was measured by 2-dimensional echocardiography ; cardiac deformation was assessed in detail by speckle-tracking echocardiography . We used cumulative exposure of BP through baseline and up to the year 25 examination ( millimeters of mercury × year ) to represent long-term exposure to BP levels . Linear regression and logistic regression were used to quantify the association of BP measured repeatedly through early adulthood ( 18 to 30 years of age ) up to middle age ( 43 to 55 years ) . RESULTS Among 2,479 participants , cumulative BP measures were not related to LV ejection fraction ; however , high cumulative exposure to systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) were associated with lower longitudinal strain rate ( both p < 0.001 ) . For diastolic function , higher cumulative exposures to SBP and DBP were associated with low early diastolic longitudinal peak strain rate . Of note , higher DBP ( per SD increment ) had a stronger association with diastolic dysfunction compared with SBP . CONCLUSIONS Higher cumulative exposure to BP over 25 years from young adulthood to middle age is associated with incipient LV systolic and diastolic dysfunction in middle age OBJECTIVE : To compare the management of mild diastolic hypertension ( 90 to 104 mm Hg ) using a nonpharmacologic intervention with that using propranolol or placebo . DESIGN : R and omized , placebo-controlled trial with a 2 × 2 factorial design . SETTING : University-based ambulatory care center . PARTICIPANTS : Two hundred seven men and 105 women , 22 to 59 years of age , 73 % white , who had mild diastolic hypertension untreated for at least eight weeks . INTERVENTIONS : 1 ) a multicomponent lifestyle modification intervention ( lifestyle focus group , or LFG ) administered in eight weekly meetings+placebo , 2 ) LFG+propranolol , 3 ) propranolol alone , and 4 ) placebo alone , followed for 12 months . MEASUREMENTS : Systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP ) , and self-reported adverse effects at each of nine follow-up visits ; fasting total cholesterol , triglycerides , and glucose at baseline and 12 months ; 24-hour urine sodium ( Na+ ) and potassium ( K+ ) , three-day food records and physical activity question naire at three and 12 months ; and a quality of life question naire at 12 months . MAIN RESULTS : The mean decreases in DBP at 12 months were : 8.5 mm Hg in the LFG+propranolol group ; 7.7 mm Hg in the propranolol-only group ; 5.9 mm Hg in the placebo-only group ; and 5.4 mm Hg in the LFG+placebo group . Repeated- measures analysis of covariance showed that level of baseline DBP ( p<0.0001 ) , time of follow-up ( p<0.0001 ) , and propranolol use ( p<0.0001 ) were significantly associated with a decrease in DBP at 12 months . Despite reductions in urinary Na+ ( −35 mEq ; 95 % CI=−50 , −19 ) , dietary Na+ ( −521 mg ; 95 % CI=−710 , −332 ) , total calories ingested ( −238 ; 95 % CI=−335 , −140 ) , and weight ( −1.4 lb ; 95 % CI=−3.7 , + 0.8 ) , and significant increases in dietary K+ ( + 294 mg ; 95 % CI=+107 , + 480 ) and in mets-minutes of exercise ( + 43 ; 95 % CI=+20 , + 67 ) at three months , assignment to the LFG intervention had no effect on DBP at three or 12 months . The subjects assigned to take propranolol more frequently reported fatigue during ordinary activities , sleep disturbance , decrease in sexual activity , and depressed feelings , when compared with the subjects taking placebo , but the numbers of study withdrawals did not differ by drug assignment . No significant difference in total cholesterol and glucose levels was observed by group assignment . Triglycerides increased significantly in the subjects assigned to propranolol ( mean difference=+20 mg/dL ; 95 % CI of difference + 1.5 , + 39 ) . There was no difference in the responses to 21 quality of life items between the subjects assigned to propranolol and those assigned to placebo . CONCLUSIONS : This multicomponent lifestyle modification intervention was unable to promote persistent behavior changes and thus was inferior to propranolol therapy for the treatment for mild diastolic hypertension . Future research should focus on single modifiable factors to lower blood pressure OBJECTIVE To determine the prevalence of hypertension in newly diagnosed type 2 diabetic patients and its association with risk factors for cardiovascular and diabetic complications . DESIGN Cross-sectional study . PATIENTS Newly diagnosed type 2 diabetic patients ( n = 3648 , mean age 52 years , 59 % male ) recruited for the UK Prospect i ve Diabetes Study ( UKPDS ) . MEASUREMENTS  Blood pressure , body mass index , waist : hip ratio , ECG signs of ischaemia and of left ventricular hypertrophy ( Minnesota code ) , fasting plasma glucose , urate , creatinine , insulin , triglycerides , high-density lipoprotein- , low-density lipoprotein- and total cholesterol , urinary albumin : creatinine ratio , retinopathy grading .  RESULTS Thirty-nine per cent of the patients ( 35 % of the males , 46 % of the females ) were hypertensive ( mean blood pressure > or = 160 systolic and /or > or = 90 mmHg diastolic 2 and 9 months after diagnosis of diabetes , or taking antihypertensive therapy ) . The hypertensive patients had a greater mean body mass index ( 30.1 versus 28.0 kg/m2 , P < 0.0001 ) than the normotensive patients . They also had higher fasting plasma triglyceride ( 1.94 versus 1.69 mmol/l , P < 0.0001 ) and insulin ( 15.0 versus 12.8 mU/l , P < 0.0001 ) levels but these associations disappeared or weakened when obesity was taken into account . Hypertensive compared with normotensive subjects suffered a higher prevalence of cardiovascular events before the diagnosis of diabetes ( 4.8 versus 2.5 % , P < 0.0001 ) , of microalbuminuria ( 
    Output:
    
Current exercise guidance provided to reduce blood pressure in younger adults is unlikely to benefit long-term cardiovascular risk .