***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: CONTEXT The clinical use of ambulatory blood pressure ( BP ) monitoring requires further validation in prospect i ve outcome studies . OBJECTIVE To compare the prognostic significance of conventional and ambulatory BP measurement in older patients with isolated systolic hypertension . DESIGN Sub study to the double-blind placebo-controlled Systolic Hypertension in Europe ( Syst-Eur ) Trial , started in October 1988 with follow up to February 1999 . The conventional BP at r and omization was the mean of 6 readings ( 2 measurements in the sitting position at 3 visits 1 month apart ) . The baseline ambulatory BP was recorded with a noninvasive intermittent technique . SETTING Family practice s and outpatient clinics at primary and secondary referral hospitals . PARTICIPANTS A total of 808 older ( aged > or = 60 years ) patients whose untreated BP level on conventional measurement at baseline was 160 to 219 mm Hg systolic and less than 95 mm Hg diastolic . INTERVENTIONS For the overall study , patients were r and omized to nitrendipine ( n = 415 ; 10 - 40 mg/d ) with the possible addition of enalapril ( 5 - 20 mg/d ) and /or hydrochlorothiazide ( 12.5 - 25.0 mg/d ) or to matching placebos ( n = 393 ) . MAIN OUTCOME MEASURES Total and cardiovascular mortality , all cardiovascular end points , fatal and nonfatal stroke , and fatal and nonfatal cardiac end points . RESULTS After adjusting for sex , age , previous cardiovascular complications , smoking , and residence in western Europe , a 10-mm Hg higher conventional systolic BP at r and omization was not associated with a worse prognosis , whereas in the placebo group , a 10-mm Hg higher 24-hour BP was associated with an increased relative hazard rate ( HR ) of most outcome measures ( eg , HR , 1.23 [ 95 % confidence interval [ CI ] , 1.00 - 1.50 ] for total mortality and 1.34 [ 95 % CI , 1.03 - 1.75 ] for cardiovascular mortality ) . In the placebo group , the nighttime systolic BP ( 12 AM-6 AM ) more accurately predicted end points than the daytime level . Cardiovascular risk increased with a higher night-to-day ratio of systolic BP independent of the 24-hour BP ( 10 % increase in night-to-day ratio ; HR for all cardiovascular end points , 1.41 ; 95 % CI , 1.03 - 1.94 ) . At r and omization , the cardiovascular risk conferred by a conventional systolic BP of 160 mm Hg was similar to that associated with a 24-hour daytime or nighttime systolic BP of 142 mm Hg ( 95 % CI , 128 - 156 mm Hg ) , 145 mm Hg ( 95 % CI , 126 - 164 mm Hg ) or 132 mm Hg ( 95 % CI , 120 - 145 mm Hg ) , respectively . In the active treatment group , systolic BP at r and omization did not significantly predict cardiovascular risk , regardless of the technique of BP measurement . CONCLUSIONS In untreated older patients with isolated systolic hypertension , ambulatory systolic BP was a significant predictor of cardiovascular risk over and above conventional BP Recent studies showed that in diabetic hypertensive patients , administration of angiotensin-converting enzyme (ACE)-inhibitors or calcium antagonists can effectively lower blood pressure ( BP ) and prevent diabetes-related cardiovascular complications with no adverse metabolic effects . We sought to assess the antihypertensive and metabolic effects of the new dihydropyridine calcium antagonist manidipine ( M ) in patients with diabetes mellitus and essential hypertension as compared with the ACE inhibitor enalapril ( E ) . After 3 weeks of placebo , 101 ( 62 men ; age range , 34 - 72 years ) hypertensives with type II diabetes mellitus were r and omized to M 10 - 20 mg or E 10 - 20 mg , od , for 24 weeks . At the end of the placebo period and the active-treatment phase , BP was measured with a mercury sphygmomanometer ( office , O ) and over the 24 h by ambulatory ( A ) monitoring . ABP recordings were analyzed to obtain 24-h , day ( 6 a.m. to midnight ) , and night ( midnight to 6 a.m. ) average systolic ( S ) and diastolic ( D ) BP and heart rate ( HR ) values . Homogeneity of the antihypertensive effect over the 24 h was assessed by the smoothness index [ SI : i.e. , the ratio between the average of the 24 hourly BP changes after treatment and the corresponding st and ard deviation ( the higher the SI , the more uniform is the BP control by treatment over the 24 h ] . The O SBP and DBP were significantly ( p < 0.01 ) and similarly reduced by M ( 16 + /- 10 and 13 + /- 6 mm Hg , n = 49 ) and E ( 15 + /- 10 and 13 + /- 6 mm Hg , n = 45 ) . The percentage of patients whose O DBP was reduced < or = 85 mm Hg ( i.e. , the value indicated to be the optimal DBP goal in diabetic hypertensives ) was similar for M ( 37 % ) and E ( 40 % ) . The reduction of 24-h BP also was similar between M ( n = 38 ) and E ( n = 38 ) for both drugs ( systolic , 6 + /- 11 and 8 + /- 10 mm Hg ; diastolic , 5 + /- 8 and 5 + /- 7 ; NS , M vs. E ) . The antihypertensive effect was distributed in a similar homogeneous fashion throughout the dosing interval , as shown by the similar SI values ( M , 0.6 + /- 1.2 for SBP and 0.6 + /- 0.9 for DBP ; E , 0.6 + /- 0.8 for SBP and 0.5 + /- 0.7 for DBP ; NS , M vs. E ) . O and A HR were unchanged by either treatment . Markers of glucose and lipid metabolism and renal function were not significantly modified by treatment both with M and with E. In the diabetic hypertensives , M was as effective and metabolically neutral as the ACE-inhibitor To determine the prognostic significance of ambulatory blood pressure , we prospect ively followed for up to 7.5 years ( mean , 3.2 ) 1187 subjects with essential hypertension and 205 healthy normotensive control subjects who had baseline off-therapy 24-hour noninvasive ambulatory blood pressure monitoring .  Prevalence of white coat hypertension , defined by an average daytime ambulatory blood pressure lower than 131/86 mm Hg in women and 136/87 mm Hg in men in clinical ly hypertensive subjects , was 19.2 % . Cardiovascular morbidity , expressed as the number of combined fatal and nonfatal cardiovascular events per 100 patient-years , was 0.47 in the normotensive group , 0.49 in the white coat hypertension group , 1.79 in dippers with ambulatory hypertension , and 4.99 in nondippers with ambulatory hypertension . After adjustment for traditional risk markers for cardiovascular disease , morbidity did not differ between the normotensive and white coat hypertension groups ( P = .83 ) . Compared with the white coat hypertension group , cardiovascular morbidity increased in ambulatory hypertension in dippers ( relative risk , 3.70 ; 95 % confidence interval , 1.13 to 12.5 ) , with a further increase of morbidity in nondippers ( relative risk , 6.26 ; 95 % confidence interval , 1.92 to 20.32 ) . After adjustment for age , sex , diabetes , and echocardiographic left ventricular hypertrophy ( relative risk versus subjects with normal left ventricular mass , 1.82 ; 95 % confidence interval , 1.02 to 3.22 ) , cardiovascular morbidity in ambulatory hypertension was higher ( P = .0002 ) in nondippers than in dippers in women ( relative risk , 6.79 ; 95 % confidence interval , 2.45 to 18.82 ) but not in men ( P = .91 ) . Our findings suggest that ambulatory blood pressures stratifies cardiovascular risk in essential hypertension independent of clinic blood pressure and other traditional risk markers including echocardiographic left ventricular hypertrophy . ( ABSTRACT TRUNCATED AT 250 WORDS The aim of this study was to evaluate the antihypertensive effect of drugs according to the initial ambulatory blood pressure ( BP ) level . After a 15-day placebo run-in period , 105 patients with moderate essential hypertension ( mean age , 52 years ) underwent  24-h BP monitoring  ( spacelabs : 1 measure/15 min ) . Patients were subdivided into two groups : the " High " group , with 24-h mean values of systolic BP ( SBP ) > 137 or diastolic BP ( DBP ) > 87 mm Hg , and the " Low " group , with SBP < or = 137 and DBP < or = 87 mm Hg . All patients received , in a r and om and double-blind design , either bisoprolol ( 10 mg q.d . ) or lisinopril ( 20 mg q.d . ) for 8 weeks . At the end of this active treatment period , office and ambulatory BP measurements were performed . Casual measurements revealed similar BP decreases in all subgroups receiving bisoprolol and lisinopril ; BP monitoring showed that the antihypertensive effect depended on the baseline mean 24-h value ; -15/-12 mm Hg for bisoprolol and -18/-13 mm Hg for lisinopril in the High group ; -7/-6 mm Hg for bisoprolol and -6/-6 mm Hg for lisinopril in the Low group . This study shows that the antihypertensive effect depended on initial ambulatory BP values , with a lower BP decrease in the Low group . Assessment of the antihypertensive effect on ambulatory BP is useful in clinical trials Objective To evaluate the antihypertensive effect of lercanidipine once a day at three different doses ( 2.5 , 5 and 10 mg ) by clinic and ambulatory blood pressure . Methods After 3 weeks of a placebo run-in , 243 mild to moderate essential hypertensives ( mean ± SD age 51 ± 8 years ) were r and omly allocated to lercanidipine at 2.5 , 5 or 10 mg or a placebo for 4 weeks , in a double-blind parallel-group design . At the end of each period , supine clinic blood pressure ( st and ard sphygmomanometry ) and 24 h ambulatory blood pressure ( Spacelabs 90207 ) were measured . The duration and homogeneity of the antihypertensive effect of the active drug compared with placebo over 24 h was evaluated by calculating the smoothness index , the ratio of the mean of the 24 hourly blood pressure changes to the corresponding SD . The higher the smoothness index , the greater and the smoother is the antihypertensive effect of a drug over the 24 h. Results In 211 patients with valid clinic blood pressure data at the end of treatment  , larger systolic/diastolic blood pressure reductions were found in the 5 mg ( 10 ± 12/8 ± 6 mmHg ; P < 0.05 versus placebo , diastolic blood pressure only ) and the 10 mg ( 12 ± 1/9 ; ± 7 mmHg ; P < 0.05 versus placebo , both pressures ) lercanidipine groups than in the placebo ( 5 ± 11/4 ± 8 mmHg ) and 2.5 mg lercanidipine ( 7 ± 12/6 ± 7 mmHg ) groups . In 105 patients with complete 24 h  ambulatory blood pressure recordings , there were significantly ( P < 0.05 versus placebo ) larger reductions in the 10 mg ( 9 ± 7/7 ± 5 mmHg ) than the 2.5 mg ( 1 ± 10/1 ± 6 mmHg ) and placebo ( 2 ± 6/1 ± 4 mmHg ) groups . The reduction in 24 h blood pressure with 5 mg lercanidipine ( 6 ± 7/4 ± 5 mmHg ) was significantly greater compared with placebo for diastolic pressure only , and when hourly average blood pressure changes were considered , this reduction did not extend to the final hours of the dosing interval . No significant changes in the clinic or 24 h heart rate were induced by placebo or lercanidipine . The smoothness index was significantly ( P < 0.05 ) lower for 2.5 mg lercanidipine and placebo ( 0.2 ± 0.5 and 
    Output:
    
A different ratio characterized the treatment-induced changes in office blood pressure and ABP in the Heart Outcomes Prevention Evaluation ( HOPE ) ABP sub study .
The effect of antihypertensive treatment is greater on office blood pressure than on ABP , and is unevenly distributed between day and night .