***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: A r and omized controlled trial of an information and medical record booklet design ed to improve patient underst and ing and participation in the management of hypertension was conducted in six inner London general practice s. After one year there were no significant differences between the group who had received the booklets and the control group in mean systolic or diastolic blood pressure , but the study group scored significantly higher on knowledge about hypertension and its management . However , the difference between the two groups was small , possibly because both groups started with a high level of underst and ing about hypertension and its management . In addition , the mean diastolic blood pressure in the control group showed that the treatment provided was already satisfactory , and that there was little need for improvement . Nevertheless , the information booklet evaluated in this study provides health professionals with a highly acceptable method of informing the patient about hypertension and its management and could be used both in hospital and general practice 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 Home measurement of blood pressure ( BP ) can improve compliance . The aim of this study was to evaluate if the efficacy of losartan in hypertension could be enhanced by providing patients with a device for home BP measurement . In this open , r and omised , prospect i ve , multi-centre study in 244 Swiss practice s , patients with mild-to-moderate hypertension were r and omised to a group receiving a home BP measuring device ( OMRON ) ( group 2 ) , or to a group where this device was not provided ( group 1 ) . After 8 weeks of treatment with losartan , the responder rates between subjects performing home measurement of BP were compared with those without self-measurement , whereby exclusively sphygmomanometric office BP values were considered . A total of 622 subjects completed the study . Treatment with losartan significantly reduced diastolic ( DBP ) and systolic BP ( SBP ) ( P < 0.0001 ) . overall , the group with home bp measurement showed an increased responder rate ( dbp ⩽90 mm hg ) by 6.4 % ( 59.8 % vs 66.2 % ; 0.05 < P < 0.1 ) . this difference was mainly due to female patients ( 64.1 % vs 73.2 % ) , where it reached statistical significance ( P < 0.01 ) . pretreated patients showed a 9.0 % improvement of response in the home measurement group as well ( 0.05 < P < 0.1 ) . the responder rate in newly treated subjects was relatively high , reaching 79.5 % ( dbp ⩽90 mm hg or reduction ⩾10 mm Hg DBP from baseline ) . However , home measurement did not significantly improve BP control in these new patients ( 81.4 % vs 77.7 % ) . Overall , home measurement can lead to a slight improvement of BP control . This improvement was most evident in females , reaching significance BACKGROUND St and ard office-based approaches to controlling hypertension show limited success . Such suboptimal hypertension control reflects in part the absence of both an infrastructure for patient education and frequent , regular blood pressure ( BP ) monitoring . We tested the efficacy of a physician-directed , nurse-managed , home-based system for hypertension management with st and ardized algorithms to modulate drug therapy , based on patients ' reports of home BP . METHODS We r and omized out patients requiring drug therapy for hypertension according to the Joint National Committee on Prevention , Detection , Evaluation , and Treatment of High Blood Pressure ( JNC VI ) criteria to receive usual medical care only ( UC , n = 76 ) or usual care plus nurse care management intervention ( INT , n = 74 ) over a 6-month period . RESULTS Patients receiving INT achieved greater reductions in office BP values at 6 months than those receiving UC : 14.2 + /- 18.1 versus 5.7 + /- 18.7 mm Hg systolic ( P < .01 ) and 6.5 + /- 10.0 versus 3.4 + /- 7.9 mm Hg diastolic , respectively ( P < .05 ) . At 6 months , we observed one or more changes in drug therapy in 97 % of INT patients versus 43 % of UC patients , and 70 % of INT patients received two or more drugs versus 46 % of UC . Average daily adherence to medication , measured by electronic drug event monitors , was superior among INT subjects ( mean + /- SD , 80.5 % + /- 23.0 % ) than among UC subjects ( 69.2 + /- 31.1 % ; t(113 ) = 2.199 , P = .03 ) . There were no significant adverse drug reactions in either group . CONCLUSIONS Telephone-mediated nurse management can successfully address many of the systems-related and patient-related issues that limit pharmacotherapeutic effectiveness for hypertension To examine the relative cost-effectiveness of single versus multiple patient education strategies to reduce hypertension , we assigned patients to seven intervention groups and to a  usual-care control group  using a r and omized factorial design . We compared cost-effectiveness measures for single , double , and triple combinations of ( a ) a clinic exit interview with patients to clarify their medical regimens , ( b ) an educational meeting with a member of the patient 's family to aid in management at home , and ( c ) a series of small group sessions to help patients overcome personal barriers to management . We observed consistent results for six different effectiveness measures under a variety of decision-making rules . Our results suggest that in the absence of targeting of multiple interventions to systematic ally selected high-risk patients , multiple intervention combinations are not more cost-effective than single interventions A clinical trial of 204 untreated patients with mild hypertension was conducted to assess the effect of  home blood pressure monitoring  on blood pressure level , pharmacologic treatment , reduction of risk factors , and use of health services .  After 1 year , no statistically significant differences were found between the treatment and control groups . The findings indicate that , while home blood pressure monitoring may be useful , it has no measurable short-term impact on these aspects of blood pressure management for patients with mild hypertension An automated surveillance system utilizing a computer-based medical record system ( COSTAR ) was design ed to improve the follow-up of patients with newly identified elevated diastolic blood pressure . A population of patients was selected where , in the 6-month period following the initial measurement of an elevated diastolic blood pressure , there were fewer than two visits during which blood pressure was recorded . In a r and omized controlled clinical trial , this poor follow-up population was divided into two groups , with computer-generated reminders being automatically generated for only patients in the experimental group . Follow-up was significantly improved in the group receiving the reminders , both in terms of rate of follow-up attempted or achieved by the responsible physician and in the repeated recording of blood pressure . We conclude that a computer-based reminder system improves follow-up of newly discovered elevation in diastolic blood pressure OBJECTIVE : To assess the effect of a physician and pharmacist teamwork approach to uncontrolled hypertension in a medical resident teaching clinic , for patients who failed to meet the recommended goals of the fifth Joint National Commission on Detection , Evaluation and Treatment of High Blood Pressure . HYPOTHESIS : Physician and pharmacist teamwork can improve the rate of meeting national blood pressure goals in patients with previously uncontrolled hypertension . DESIGN : A single-blinded r and omized controlled trial lasting 6 months . SETTING : A primary care outpatient teaching clinic . PATIENTS : A sample of 95 adult hypertensive patients who failed to meet national blood pressure goals based on three consecutive visits over a 6-month period . INTERVENTION : Patients were r and omly assigned to a control arm of st and ard medical care or to an intervention arm in which a physician and pharmacist worked together as a team . MAIN RESULTS : At study completion , the percentage of patients achieving national goals due to intervention was more than double the percentage in the control arm ( 55 % vs 20 % , p < .001 ) . Systolic blood pressure declined 23 mm Hg in the intervention arm versus 11 mm Hg in the control arm ( p < .01 ) . Diastolic blood pressure declined 14 and 3 mm Hg in the intervention and control arms , respectively ( p < .001 ) . The intervention worked equally as well in men and women and demonstrated noticeable promise in a minority of mixed-ancestry Hawaiians in whom hypertension is of special concern . CONCLUSIONS : Patients who fail to achieve national blood pressure goals under st and ard outpatient medical care may benefit from a program that includes a physician and pharmacist teamwork approach Does free medical care lead to better health than insurance plans that require the patient to shoulder part of the cost ? In an effort to answer this question , we studied 3958 people between the ages of 14 and 61 who were free of disability that precluded work and had been r and omly assigned to a set of insurance plans for three or five years . One plan provided free care ; the others required enrollees to pay a share of their medical bills . As previously reported , patients in the latter group made approximately one-third fewer visits to a physician and were hospitalized about one-third less often . For persons with poor vision and for low-income persons with high blood pressure , free care brought an improvement ( vision better by 0.2 Snellen lines , diastolic blood pressure lower by 3 mm Hg ) ; better control of blood pressure reduced the calculated risk of early death among those at high risk . For the average participant , as well as for subgroups differing in income and initial health status , no significant effects were detected on eight other measures of health status and health habits . Confidence intervals for these eight measures were sufficiently narrow to rule out all but a minimal influence , favorable or adverse , of free care for the average participant . For some measures of health in subgroups of the population , however , the broader confidence intervals make this conclusion less certain BACKGROUND We compared blood pressure ( BP ) control in a recent cohort of hypertensive military veterans with BP control in a previous cohort and examined whether hypertension treatment practice s , as defined by the frequency of antihypertensive medication dosage increases , have changed over time . METHODS We abstract ed 1999 outpatient chart data including visit type , BP measurements , comorbidities , and medication use for 981 r and omly selected hypertensive veterans . We examined overall BP control and control in subgroups with diabetes mellitus and renal disease , and compared results with those of a sample of 800 veterans studied from 1990 to 1995 . We also compared the frequency of antihypertensive medication dosage increases in the 2 sample s. RESULTS Mean BPs were significantly lower in 1999 . The mean systolic drop was 3.1 mm Hg and reached 13.7 mm Hg for the subgroups with diabetes and renal disease . Even larger decreases were seen in mean diastolic BPs . In 1999 , 57 % of patients had BP measurements of 140/90 mm Hg or higher , vs 69 % of patients in the 1990 - 1995 study ( P<.001 ) . In 1999 , the BP control of patients with diabetes was similar to that of patients without diabetes , as 60 % of the former had BP measurements of 140/90 mm Hg or higher . Patients with renal disease had better control than those without , however , as only 43 % had BP measurements of 140/90 mm Hg or higher . When comparing sample s , patients with diabetes , renal disease , or both had better BP control in 1999 than their counterparts in the 1990 - 1995 study ( P<.003 in all cases ) . In 1999 , more medical visits were associated with medication dosage increases than in the 1990 - 1995 study . CONCLUSIONS Although overall BP control has improved , BP measurements still exceeded recommended levels in most patients . For patients with diabetes and renal disease  BP was much better controlled in the more recent sample . However , BP control of patients with diabetes was similar to that of patients without diabetes , and not in agreement with the guideline -recommended tighter control . Thus , room for improvement remains , especially in this subgroup OBJECTIVE To evaluate the implementation of clinical guidelines for hypertension in general practice by use of a computer-based clinical decision support system ( CDSS ) and a specific implementation strategy . Evaluation of patient outcome . DESIGN R and omised study with health centres as units . The intervention group had the CDSS installed and made ready for use , doctors and assistants were trained and received a user-manual , the doctors were offered telephone repetitions , a seminar in risk intervention and , at the same seminar , further demonstration of the CDSS . The doctors received baseline registration s with information of how they treated their own hypertensive patients , and use of the CDSS was checked repeatedly . SETTING General practice in Sør- and Nord-Trøndelag counties in Norway , 380,000 inhabitants . PARTICIPANTS Seventeen health centres with 24 doctors and 984 patients in the 
    Output:
    
General practice s and community-based clinics need to have an organised system of regular follow-up and review of their hypertensive patients .