***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: Objective : To examine the efficacy of a new device , which slows and regularises breathing , as a non-pharmacological treatment of hypertension and thus to evaluate the contribution of breathing modulation in the blood pressure ( BP ) reduction . Design and setting : R and omised , double-blind controlled study , carried out in three urban family practice clinics in Israel . Patients : Sixty-five male and female hypertensives , either receiving antihypertensive drug therapy or unmedicated . Four patients dropped out at the beginning of the study .Intervention : Self treatment at home , 10 minutes daily for 8 consecutive weeks , using either the device ( n = 32 ) , which guides the user towards slow and regular breathing using musical sound patterns , or a Walkman , with which patients listened to quiet music ( n = 29 ) . Medication was unchanged 2 months prior to and during the study period . Main outcome measures : Systolic BP , diastolic BP and mean arterial pressure ( MAP ) changes from baseline . Results : BP reduction in the device group was significantly greater than a predetermined ‘ clinical ly meaningful threshold ’ of 10.0 , 5.0 and 6.7 mm Hg for the systolic BP , diastolic BP and MAP respectively ( P = 0.035 , P = 0.0002 and P = 0.001 ) . Treatment with the device reduced systolic BP , diastolic BP and MAP by 15.2 , 10.0 and 11.7 mm Hg respectively , as compared to 11.3 , 5.6 and 7.5 mm Hg ( P = 0.14 , P = 0.008 , P = 0.03 ) with the Walkman . Six months after treatment had stopped , diastolic BP reduction in the device group remained greater than the ‘ threshold ’ ( P < 0.02 ) and also greater than in the walkman group ( P = 0.001 ) . Conclusions : The device was found to be efficacious in reducing high BP during 2 months of self-treatment by patients at home . Breathing pattern modification appears to be an important component in this reduction The purpose of the present study was to test the effectiveness of a  cognitive-behavioral intervention  as an adjunctive treatment of hypertension . To qualify for the study , subjects had to have an unmedicated clinic diastolic blood pressure > or = 95 mm Hg . After qualification , minimal drug requirements were established using a diuretic and a beta-blocker to control blood pressure at < or = 90 mm Hg . Subjects were then r and omized into a 6-week cognitive-behavioral intervention or a measurements -only control group . After the treatment phase , medication levels were reduced in all subjects by means of a systematic stepdown procedure . Subjects were followed for 1 year after the stepdown was completed . Addition of the cognitive-behavioral intervention was twice as effective as the control procedure in reducing drug requirements . At 12-months follow-up , 73 % of the treatment group were at lower levels of medication than at the time of r and omization , compared to 35 % in the control group . Moreover , 55 % of the treatment group remained completely free of medication , compared to 30 % of the control group , at the 12-month follow-up . The reductions in medication were associated with maintained controlled levels of clinic , ambulatory , and home blood pressure . The addition of a st and ardized and inexpensive group-administered cognitive-behavioral intervention to the drug treatment of hypertension is beneficial as an adjunctive treatment in reducing drug requirements for patients with hypertension , thereby reducing the costs and potential side effects of antihypertensive medications Thirty-three moderate hypertensives were converted to a 2-drug regimen of metoprolol and diuretic and BPs stabilized at a well-controlled level . They then completed one of three conditions over an 8-week interval : ( I ) 16 sessions of TBF ( h and and foot warming ) ; ( II ) 16 sessions of frontal EMG-BF ; ( III ) regular home monitoring of BP . Attempts were then made to withdraw the patients from the sympatholytic medication . Those successfully withdrawn were followed up for one year . There were no significant advantages for TBF over the other two conditions in the short term or with long-term follow-up . Only 27 % of treated patients ( including Condition III failures who were remedicated and treated with TBF ) were successfully off of the sympatholytic at a one-year follow-up . The generally poor results on clinical outcome were confirmed by clinic BPs , home BPs by patients , and 24-hour ambulatory BPs On screening 192 men and women aged 35 - 64 were identified as having two or more of the following risk factors : blood pressure greater than or equal to 140/90 mm Hg , plasma cholesterol concentration greater than or equal to 6.3 mmol/l ( 243.6 mg/100 ml ) , and current smoking habit greater than or equal to 10 cigarettes a day . They were r and omly allocated to a group for modification of behaviour or to serve as controls . Both groups were given health education leaflets containing advice to stop smoking , to reduce animal fats in the diet , and on the importance of reducing blood pressure . In addition , the treatment group had group sessions of one hour a week for eight weeks in which they were taught breathing exercises , relaxation , and meditation and about managing stress . It had previously been found that after eight weeks and eight months there was a significantly greater reduction in both systolic and diastolic blood pressures in the group taught to relax compared with the control group . After four years of follow up these differences in blood pressure were maintained . Plasma cholesterol concentration and the number of cigarettes smoked were lower in the treatment group at eight weeks and eight months but not at the four year follow up . At four years more subjects in the control group reported having had angina and treatment for hypertension and its complications . Incidence of ischaemic heart disease , fatal myocardial infa rct ion , or electrocardiographic evidence of ischaemia was significantly greater in the control group . If the results of this study could be obtained in a larger study the financial and health care implication s would be enormous & NA ; This industry‐based r and omized study compared the effects of behavioral treatment ( BT ) and blood pressure monitoring ( BPM ) on blood pressure ( BP ) change in 158 unmedicated persons with mild hypertension ( diastolic blood pressure 90 to 104 mm Hg ) . Participants recruited by a three‐stage screening were r and omly assigned to BT or BPM groups and stratified by entry diastolic blood pressure ( DBP ) , age , and sex . BT participants received relaxation training , with or without the addition of biofeedback , cognitive restructuring , and health behavior change components . During the study , all participants were followed by their usual care physicians and received medical advice . At 18 weeks into the study , after the BT groups completed training , both the BT and BPM groups showed significant reductions in systolic blood pressure ( SBP ) and DBP assessed in the company medical clinic ( 7.4 and 9.0 mm Hg SBP and 4.5 and 5.9 mm Hg DBP , respectively ) . These reductions were maintained throughout the 36‐week follow‐up period . Reductions in BP assessed at the participants ' worksite were similar for BT and BPM participants throughout most of the trial , indicating little advantage to the inclusion of behavioral interventions over monitoring alone . Differences in BP changes observed among participants receiving various combinations of behavioral treatment components indicated that the cognitive restructuring component reduced SBP in the worksite by an additional 5.4 mm Hg ( p less than 0.05 ) . Possible explanations for the BP changes observed in the BPM group and implication s of the results for the treatment of unmedicated mild hypertensives are discussed The present study compared the effectiveness of three procedures in the treatment of 34 individuals with essential hypertension : ( 1 ) stress management training plus relaxation imagery , which consisted of an adaptation of existing stress management techniques in conjunction with extensive relaxation training using relaxation imagery ; ( 2 ) relaxation imagery alone ; and ( 3 ) weekly blood pressure checks . The relaxation imagery technique involved visualization of a relaxing image along with concentration on suggestions of relaxation , heaviness , and warmth . Treatment was individualized and lasted 8 weeks . Results indicated stress management plus relaxation imagery and relaxation imagery alone were significantly more effective than blood pressure checks in reducing systolic and diastolic blood pressures during treatment and in maintaining diastolic blood pressure reductions during follow-up . However , no significant differences were found between the two treatment procedures . Clinical implication s of these findings are discussed BACKGROUND To our knowledge , no single investigation concerning the long-term effects of overweight status on the risk for hypertension , hypercholesterolemia , diabetes mellitus , and cardiovascular sequelae has been reported . METHODS Relations between categories of body mass index ( BMI ) , cardiovascular disease risk factors , and vascular disease end points were examined prospect ively in Framingham Heart Study participants aged 35 to 75 years , who were followed up to 44 years . The primary outcome was new cardiovascular disease , which included angina pectoris , myocardial infa rct ion , coronary heart disease , or stroke . Analyses compared  overweight ( BMI [ calculated as weight in kilograms divided by the square of height in meters ] , 25.0 - 29.9 ) and obese persons ( BMI > or = 30 )  to a  referent group of normal-weight persons ( BMI , 18.5 - 24.9 ) . RESULTS The age-adjusted relative risk ( RR ) for new hypertension was highly associated with overweight status ( men : RR , 1.46 ; women : RR , 1.75 ) . New hypercholesterolemia and diabetes mellitus were less highly associated with excess adiposity . The age-adjusted RR ( confidence interval [ CI ] ) for cardiovascular disease was increased among those who were overweight ( men : 1.21 [ 1.05 - 1.40 ] ; women : 1.20 [ 1.03 - 1.41 ] ) and the obese ( men : 1.46 [ 1.20 - 1.77 ] ; women : 1.64 [ 1.37 - 1.98 ] ) . High population attributable risks were related to excess weight ( BMI > or = 25 ) for the outcomes hypertension ( 26 % men ; 28 % women ) , angina pectoris ( 26 % men ; 22 % women ) , and coronary heart disease ( 23 % men ; 15 % women ) . CONCLUSIONS The overweight category is associated with increased relative and population attributable risk for hypertension and cardiovascular sequelae . Interventions to reduce adiposity and avoid excess weight may have large effects on the development of risk factors and cardiovascular disease at an individual and population level Controlled studies have demonstrated that relaxation training can lead to significant in-clinic blood pressure ( BP ) reductions in patients with essential hypertension . We examined the BP-lowering effect of relaxation training during the working day . Forty-two patients being treated for essential hypertension with diastolic BPs greater than 90 mm Hg were r and omized into either a relaxation training program or no treatment .  Multiple BP measurements were made during the working hours , using an ambulatory monitoring device , before and after training . Significant work-site differences between groups were evident after treatment both for systolic and diastolic pressures . These results suggest that relaxation therapy leads to a reduction in BP that is evident in the natural environment , providing new evidence that the procedure is a useful adjunct to the treatment of hypertensive patients & NA ; This article reports the findings of a study design ed to evaluate the long‐term effectiveness of an industry‐based relaxation training program in the treatment of hypertensives whose blood pressures were not well controlled by antihypertensive medication . Following a three‐stage screening process , 137 participants were r and omly allocated to either relaxation training ( RT ) or to blood pressure monitoring ( BPM ) at two worksites . Participants continued to receive medical care from their primary physicians during the course of the study . The advantage for participants receiving RT , in terms of mean blood pressure changes , was modest and of short duration . However , a larger proportion of participants in the RT group came into good control ( blood pressures below 90 mm Hg ) than in the BPM group following treatment ( 69.4 % vs 41.5 % , p less than 0.001 ) . This advantage continued to 24 months ' follow‐up ( 63.9 % vs 47.7 % , p less than 0.05 ) . At 30 months ' follow‐up there was no significant difference between the groups ( 75.0 % vs 70.8 % ) . Within‐group analyses revealed that the BPM group also achieved significant blood pressure lowering which was maintained during the study . The largest initial difference between the two groups was for individuals whose entry diastolic blood pressures were most out of control despite several years of pharmacologic treatment . No difference was found between the two groups in the prescription of antihypertensive medication Fifty-two pharmacologically treated hypertensive patients were r and omized to one of four treatment groups : ( 1 ) diastolic blood pressure biofeedback , ( 2 ) progressive deep muscle relaxation training , ( 3 ) self-directed relaxation training , or ( 4 ) medication alone . Data collection occurred during baseline , treatment , and 1-year follow-up phases in a laboratory , a medical clinic , and the patient 's own home . Patients from all four groups combined showed mean blood pressure reductions of −10.2/−5.5 mm Hg on clinic recordings and −2.4/−.7 mm Hg on home recordings , which were maintained throughout the follow-up period . There were no significant differences among the four groups in terms of blood pressure reduction . Patients given adjunctive behavioral treatment showed significantly larger reductions in medication usage compared to patients 
    Output:
    
In terms of antihypertensive medication , no favorable effects of stress-reduction techniques could be identified .