***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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    ***EXAMPLES*** 
    Input: Blood pressure can be determined more precisely with the use of 24 hours ambulatory measurement in type 1 diabetics .  Nitric oxide ( NO ) has been suggested to be responsible for the vascular changes described in early diabetic nephropathy . We aim ed to investigate serum NO concentration along with ambulatory blood pressure monitoring ( ABPM ) parameters in type 1 diabetic patients and to find out whether there are correlation between serum NO level and ABPM parameters . Forty type 1 diabetic subjects and 35 controls were enrolled . Diabetic subjects were grouped as microalbuminuric ( n=16 ) and normalbuminuric ( n=24 ) .  Casual and ambulatory blood pressure parameters and serum NO concentrations were measured in all study population . Microalbuminuric subjects had higher nighttime systolic blood pressure ( SBP ) , 24 hours diastolic blood pressure ( DBP ) and 24 hours mean arterial pressure ( MAP ) than controls . Both microalbuminuric and normalbuminuric subjects had also significantly higher nighttime DBP and nighttime MAP than controls . Serum NO concentrations were higher in normalbuminuric and microalbuminuric subjects than controls . Serum NO concentrations were positively correlated with daytime DBP and MAP , nighttime SBP , DBP and MAP , and 24 hours DBP and MAP in microalbuminuric subjects . Serum NO concentrations were also positively correlated with nighttime DBP in normalbuminuric subjects . Multiple linear regression analysis revealed that serum NO(2)- + NO(3)- concentrations and 24 hours DBP were independently associated with the development of microalbuminuria . Albuminuria seems to be closely associated with serum NO concentrations and ABPM parameters in type 1 DM patients . A prospect i ve follow-up study on diabetic patients with normo- and micro- albuminuria is needed to confirm the predictive values of increased NO concentrations and ABPM parameters on the development of albuminuria Abstract . Recently , an international consensus paper was published for st and ardization of home self-blood pressure ( BP ) measurement in adults . However , few data exist regarding home BP measurement in children , although it is recommended for all pediatric patients on renal replacement therapy in Germany . Therefore , a survey was performed among German-speaking pediatric nephrologists ( members of the Arbeitsgemeinschaft Pädiatrische Nephrologie ) in order to study their opinions about home blood pressure measurements . Approximately 75 % of German pediatric nephrology centers responded to the survey . More than 70 % of the interviewees prescribed a blood pressure device for all children with renal diseases and hypertension or on renal replacement therapy . For children with antihypertensive medication , 2.8 daily measurements were recommended at mean and 2.2 measurements for children without therapy .  Auscultation of Korotkoff sounds and oscillometric BP measurements  were used in the same percentage for home BP recordings . The upper cut of level for home blood pressure values was rated by the pediatric nephrologists and compared to reference values of casual blood pressure . There was good agreement for upper systolic BP , but as many as 40 to 50 % of the interviewees accepted upper diastolic BP values higher than the 97th percentile for casual BP .  Home BP measurement  was judged to be more important than office BP measurement  by 64 % of the nephrologists and less important than 24 h ambulatory blood pressure monitoring by 67 % . The results of the survey showed wide discrepancies for st and ards of home BP measurement in children and adolescents , especially for the recommendations for upper diastolic BP . Before home blood pressure measurements can be recommended unrestrictedly in children and adolescents , we stress the need for st and ardization of blood pressure devices and measurement . Prospect i ve studies in children are needed to demonstrate that these st and ards facilitate better prediction of cardiovascular outcome using home BP measurements compared to office BP recordings in children Whereas the diurnal fall of BP ( dipping ) is an important prognostic marker in patients with chronic renal failure ( CRF ) , the integrity of physiologic ultradian ( i.e. , shorter than 24 h ) cardiovascular rhythms in patients with CRF is unknown . Also , the relationship between conventional dipping analysis and Fourier spectral rhythm analysis has not been examined in renal hypertension . The prevalence and dimensions of the circadian and three ultradian ( 12 , 8 , and 6 h ) cardiovascular rhythms were studied by ambulatory BP monitoring in 214 children ( aged 3 to 18 yr ) with CRF ( stage 2 to 4 chronic kidney disease ) and no antihypertensive treatment compared with 938 healthy control subjects , and the relationship of rhythm characteristics to conventional dipping parameters , renal function , proteinuria , and serum electrolytes was assessed . The CRF cohort exhibited significantly reduced amplitudes of the circadian and all ultradian cardiovascular rhythms studied ( all P < 0.01 ) . Moreover , all BP and most heart rate rhythms showed significantly delayed acrophases ( time of peak ; P < 0.01 ) . Whereas conventional BP dipping parameters ( day/night difference , day/night ratio ) and the 24-h BP amplitude were independent of renal function , the 8-h BP amplitude was positively correlated with GFR ( r = 0.3 , P = 0.01 ) and inversely correlated with the urinary protein/creatinine ratio ( r = -0.27 , P < 0.05 ) , and the 6-h BP amplitude was inversely correlated with proteinuria ( r = -0.3 , P < 0.02 ) . Children who displayed 24- or 12-h cardiovascular rhythms had significantly lower serum calcium levels than children without these rhythms . In summary , children with CRF display not only blunted circadian but also blunted ultradian cardiovascular rhythms . Ultradian but not circadian rhythms or conventional dipping parameters are quantitatively associated with renal function and proteinuria BACKGROUND Left-ventricular hypertrophy ( LVH ) is a risk factor for cardiovascular morbidity . Antihypertensive treatment with angiotensin-converting enzyme inhibitors ( ACEI ) is able to induce the regression of LVH in adults . However , there has been no study of the ability of ACEI to induce the regression of LVH in children . Our aim was to investigate the effect of ramipril on left-ventricular mass and blood pressure ( BP ) in hypertensive children . METHODS Twenty-one children ( median age , 15 years ) with renal ( 76 % ) or primary ( 24 % ) hypertension were prospect ively treated with ramipril monotherapy for 6 months . Blood pressure was evaluated using ambulatory BP monitoring , with hypertension defined as mean BP > or=95th percentile . Left-ventricular hypertrophy was defined either as left-ventricular mass index ( LVMI ) > 38.6 g/m(2.7 ) ( pediatric definition ) or as LVMI > 51.0 g/m(2.7 ) ( adult definition ) . RESULTS Nineteen children completed the study . The median LVMI decreased from 36.8 g/m(2.7 ) ( range , 18.9 to 55.8 g/m(2.7 ) ) to 32.6 g/m(2.7 ) ( range , 19.0 to 52.1 g/m(2.7 ) ; P < .05 ) after 6 months . The prevalence of LVH decreased from 42 % to 11 % using the pediatric definition ( P < .05 ) and did not change using the adult definition ( ie , it remained at 5 % ) . The median ambulatory BP decreased by 11 , 7 , 8 , and 7 mm Hg for daytime systolic , daytime diastolic , nighttime systolic , and nighttime diastolic BP ( P < .05 ) , respectively . A positive correlation was found between LVMI and nighttime systolic BP at the start of the study ( r = 0.46 , P < .05 ) . CONCLUSIONS Ramipril is an effective drug in children with hypertension , for its ability to reduce not only BP but also left-ventricular mass and induce regression of LVH Background : Hypertension is a frequent complication of end-stage renal disease and left ventricular hypertrophy ( LVH ) is common in patients with poorly controlled hypertension . The aim of this study was to evaluate hypertension in pediatric peritoneal dialysis ( PD ) patients , to compare casual and ambulatory blood pressure ( BP ) measurements and to evaluate the impact of BP parameters on LVH . Methods : The study comprised 25 PD patients ( 9 M , 16 F ; mean age 14.14 ± 3.32 years ) that have been followed in outpatient clinics . Medical records were review ed for demographic features ;  casual BP measurements , ambulatory blood pressure monitoring ( ABPM ) and echocardiographic evaluation were applied to all patients . Results : The mean 24-hour and daytime systolic blood pressure ( SBP ) values were found to be higher than casual SBP ( p < 0.001 ) . Significant difference was present in the frequency of hypertension between casual SBP ( 32 % ) and the mean daytime SBP ( 56 % ) ( p < 0.05 ) . Nighttime systolic hypertension was detected in 14 ( 56 % ) and diastolic hypertension in 16 ( 64 % ) patients . Elevated daytime SBP load and DBP load were detected in 64 and 76 % of the patients , respectively . Elevated nighttime SBP load and DBP load were detected in 72 % of the patients . Seventeen ( 68 % ) patients had attenuated dipping for SBP . The mean left ventricular mass index ( LVMI ) was 52.65 ± 18.17 g/m2.7 and 13 ( 52 % ) patients had LVH . LVMI was significantly correlated with casual BP measurements and the majority of ABPM parameters . Conclusion : The majority of pediatric PD patients  had BP abnormalities in which severity was most accurately assessed with ABPM . Casual BP and majority of ABPM parameters were found to be significantly correlated with LVMI . Ambulatory blood pressure monitoring should be performed in all pediatric PD patients BACKGROUND Angiotensin-converting enzyme inhibitors are the drugs of choice in renal hypertension . The efficacy and safety of ramipril in adults has been proved ; however , data on effectiveness of ramipril in children are few . The aim of the present study was to investigate the effect of ramipril on blood pressure ( BP ) and proteinuria in children with chronic kidney diseases . METHODS A total of 31 children ( median age 11.3 years , range 1.9 - 19.8 years ) with various chronic nephropathies and hypertension or proteinuria were prospect ively treated with ramipril for 6 months . Blood pressure was evaluated using ambulatory BP monitoring and hypertension was defined as mean BP equal to or greater than the 95th percentile for healthy children .  Proteinuria was defined as protein excretion > or = 100 mg/m(2)/24 h. The starting dose of ramipril was 1.5 mg/m(2)/24 h once daily . In 27 children it was given as monotherapy . RESULTS The median decrease in ambulatory BP was 11 mm Hg for daytime systolic , 10 mm Hg for daytime and nighttime diastolic , and 8 mm Hg for nighttime systolic BP . Hypertension normalized in 55 % of the children . Proteinuria decreased in 84 % of the children with pathologic proteinuria ; the median decrease was 51 % . A positive correlation was found between initial proteinuria and change of proteinuria ( r = 0.95 , P < .001 ) . Glomerular filtration rate and serum potassium level did not change significantly . One child developed a cough that was believed to be related to ramipril . CONCLUSIONS Ramipril is an effective and safe drug in children with chronic kidney diseases associated with hypertension , proteinuria , or both BACKGROUND While the antihypertensive and renoprotective potency of angiotensin-converting enzyme ( ACE ) inhibitors is well-established in adults with hypertension and /or chronic renal failure , little experience exists in pediatric chronic kidney disease . METHODS As part of a prospect i ve assessment of the renoprotective efficacy of ACE inhibition and intensified blood pressure ( BP ) control , 397 children ( ages 3 to 18 years ) with chronic renal failure [ CRF ; glomerular filtration rate ( GFR ) 11 to 80 mL/min/1.73 m2 ] and elevated or high-normal BP received ramipril ( 6 mg/m2 ) following a 6-month run-in period including a two-month washout of any previous ACE inhibitors .  Drug efficacy was assessed by two monthly office BP and proteinuria assessment s , and by ambulatory BP monitoring at start and after 6 months of treatment . RESULTS In the 352 patients completing six months of treatment , 24-hour mean arterial pressure ( MAP ) had decreased by a mean of 11.5 mm Hg ( -2.2 SDS ) in initially hypertensive subjects , but only by 4.4 mm Hg ( -0.8 SDS ) in patients with initially normal BP . A linear correlation was found between MAP at baseline and the change of MAP during treatment ( r= 0.51 ; P < 0.0001 ) . The antihypertensive response was independent of changes in concomitant 
    Output:
    
The available evidence suggests a moderate but significant association between ambulatory BP  and pre clinical organ damage , mainly based on studies in nephropathy and /or diabetes .