***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: In this multicentre , prospect i ve , r and omized , open-label , blinded-endpoint ( PROBE ) study , the efficacy of 12 weeks ' treatment with once-daily telmisartan 40–80 mg and enalapril 10–20 mg was evaluated using ambulatory blood pressure monitoring ( ABPM ) in 522 patients with mild-to-moderate essential hypertension . Patients were titrated to the higher dose of study drug at week 6 if mean seated diastolic blood pressure ( DBP ) was ≥ 90 mmHg . The primary endpoint was the change from baseline in ambulatory DBP in the last 6 h of the 24-h dosing interval after 12 weeks ' treatment . Telmisartan and enalapril produced similar reductions from baseline in DBP and systolic blood pressure ( SBP ) over all ABPM periods evaluated ( last 6 h , 24-h , daytime and night-time ) . Telmisartan produced a significantly greater reduction in mean seated trough DBP , measured unblinded with an automated ABPM device in the clinic , amounting to a difference of −2.02 mmHg ( P < 0.01 ) . A significantly greater proportion of patients achieved a seated diastolic response  with telmisartan than enalapril ( 59 % versus 50 % ; P < 0.05 ) , also measured with the same ABPM device . Both treatments were well tolerated . Compared with telmisartan , enalapril was associated with a higher incidence of cough ( 8.9 % versus 0.8 % ) and hypotension ( 3.9 % versus 1.1 % ) . Therefore , telmisartan may provide better long-term compliance and , consequently , better blood pressure control than enalapril BACKGROUND Blood pressure ( BP ) has a circadian pattern with a morning surge that is associated with an increased risk of acute coronary and cerebrovascular events . In a prospect i ve , r and omized , open-label , blinded-endpoint , parallel-group , multicenter , forced-titration study of telmisartan and ramipril , the efficacy of both drugs on mean ambulatory diastolic BP ( DBP ) and systolic BP ( SBP ) during the last 6 h of a 24-h dosing interval was evaluated . METHODS After screening and a single-blind run-in phase , 812 adults with mild-to-moderate hypertension ( defined as a mean seated DBP > or = 95 mm Hg and < or = 109 mm Hg and a 24-h ABPM mean DBP 7 > or = 85 mm Hg ) were r and omized to the open-label , 14-week , forced-titration , active-treatment phase as follows : telmisartan 40 mg/80 mg/80 mg ( n = 405 ) or ramipril 2.5 mg/5 mg/10 mg ( n = 407 ) , once daily in the morning . The primary efficacy variable was change from baseline in the last 6-h mean DBP and SBP at 8 and 14 weeks as assessed by  ambulatory BP monitoring  ( ABPM ) . Secondary efficacy variables were changes from baseline in BP control during each of the 24-h periods and in-clinic trough cuff BP . RESULTS Telmisartan 80 mg was superior to ramipril 5 mg and 10 mg in change from baseline in the last 6-h ABPM mean DBP and SBP at both 8 and 14 weeks ( both P < .0001 ) , respectively . At 14 weeks , the adjusted mean change from baseline in DBP for telmisartan 80 mg was -8.8 mm Hg compared with that for ramipril 10 mg of -5.4 mm Hg ( P < .0001 ) . For SBP , the adjusted mean change from baseline for telmisartan 80 mg was -12.7 mm Hg compared with that for ramipril 10 mg of -7.9 mm Hg ( P < .0001 ) . At 14 weeks , telmisartan 80 mg also yielded superior reductions from baseline in trough cuff BP compared with ramipril 10 mg ( DBP : -11.0 mm Hg v -7.8 mm Hg , respectively ; SBP : -14.3 mm Hg v -9.1 mm Hg , respectively ; both P < .0001 ) . Measures of 24-h BP control favored telmisartan 80 mg versus ramipril 10 mg ( P < .0001 ) , as did other secondary ABPM endpoints during the daytime , night-time , and morning periods . Treatment-related adverse events were uncommon ; patients treated with ramipril had a higher incidence of cough than those treated with telmisartan ( 10.1 % v 1.5 % , respectively ) . CONCLUSIONS Telmisartan 80 mg was consistently more effective than ramipril 10 mg in reducing both DBP and SBP during the last 6 h of the dosing interval , a measure of the early morning period when patients are at greatest risk of life-threatening cardiovascular and cerebrovascular events . Telmisartan 80 mg was also more effective than ramipril 10 mg in reducing BP throughout the entire 24-h dosing interval . Both drugs were well tolerated BACKGROUND This study compared the effects of losartan and perindopril on plasma plasminogen activator inhibitor-1 ( PAI-1 ) and fibrinogen in hypertensive type 2 diabetic patients . METHODS We studied 85 nonsmoking out patients , aged 46 to 64 years , with mild to moderate essential hypertension ( diastolic blood pressure [ BP ] > 90 and < 110 mm Hg ) and well controlled type 2 diabetes mellitus . After a 4-week washout placebo period , patients were r and omized to received perindopril 4 mg once daily ( n = 42 ) or losartan 50 mg once daily ( n = 43 ) for 12 weeks according to a double-blind , parallel-group design . At the end of the placebo and active treatment periods , BP was measured and plasma PAI-1 and fibrinogen were evaluated . RESULTS Both perindopril and losartan reduced systolic and diastolic BP values ( -16/15 mm Hg and -15/14 , respectively ; P < .001 v placebo ) , with no difference between the two treatments . Plasma PAI-1 was reduced by perindopril ( -10 ng/dL , P = .028 v placebo ) but not by losartan ( + 4 ng/dL , NS ) , the difference between the two treatments being statistically significant ( P < .01 ) . Plasma fibrinogen showed no significant change with both drugs , although a decreasing trend was noted with perindopril . CONCLUSIONS These findings indicate that perindopril but not losartan decreases PAI-1 in hypertensive type 2 diabetic patients , which suggests that the PAI-1 lowering effect is unrelated with AT , receptor blockade and could rather be due to the fact that the endothelial receptors that mediate PAI-1 expression in response to angiotensin II are not type 1 receptor subtypes . Different effects of the two drugs on the bradykinin system might also be implicated BACKGROUND Few studies have directly compared the renoprotective effects of angiotensin II-receptor blockers and angiotensin-converting-enzyme ( ACE ) inhibitors in persons with type 2 diabetes . METHODS In this prospect i ve , multicenter , double-blind , five-year study , we r and omly assigned 250 subjects with type 2 diabetes and early nephropathy to receive either the angiotensin II-receptor blocker telmisartan ( 80 mg daily , in 120 subjects ) or the ACE inhibitor enalapril ( 20 mg daily , in 130 subjects ) . The primary end point was the change in the glomerular filtration rate ( determined by measuring the plasma clearance of iohexol ) between the baseline value and the last available value during the five-year treatment period . Secondary end points included the annual changes in the glomerular filtration rate , serum creatinine level , urinary albumin excretion , and blood pressure ; the rates of end-stage renal disease and cardiovascular events ; and the rate of death from all causes . RESULTS After five years , the change in the glomerular filtration rate was -17.5 ml per minute per 1.73 m2 ( where the minus sign denotes a decrement ) in the telmisartan-treated subjects , as compared with -15.0 ml per minute per 1.73 m2 in the enalapril-treated subjects ; the treatment difference was thus -2.6 ml per minute per 1.73 m2 ( 95 percent confidence interval , -7.1 to 2.0 ml per minute per 1.73 m2)[corrected ] The lower boundary of the confidence interval , in favor of enalapril , was greater than the predefined margin of -10.0 ml per minute per 1.73 m2 , indicating that telmisartan was not inferior to enalapril . The effects of the two agents on the secondary end points were not significantly different after five years . CONCLUSIONS Telmisartan is not inferior to enalapril in providing long-term renoprotection in persons with type 2 diabetes . These findings do not necessarily apply to persons with more advanced nephropathy , but they support the clinical equivalence of angiotensin II-receptor blockers and ACE inhibitors in persons with conditions that place them at high risk for cardiovascular events BACKGROUND When blood pressure (BP)-lowering efficacy is assessed by measurements taken in a clinic setting , angiotensin II-receptor antagonists show similar efficacy to angiotensin-converting enzyme inhibitors and better tolerability . A search of MEDLINE to date , however , reveals no r and omized , double-blind studies using ambulatory BP monitoring ( ABPM ) to compare the BP-lowering efficacy of irbesartan and enalapril in a large number of patients ( > 200 ) with essential hypertension . OBJECTIVE This study compared 24-hour BP reduction and BP control , as assessed by ABPM , in patients with mild to moderate essential hypertension treated with irbesartan or enalapril .  The relative tolerability of the 2 treatments was also evaluated . METHODS This was a multicenter , r and omized , double-blind study in patients with mild to moderate essential hypertension ( office diastolic BP [ DBP ] 90 - 109 mm Hg or systolic BP [ SBP ] 140 - 179 mm Hg ) . After a 3-week , single-blind placebo washout phase , patients with a mean daytime DBP > or = 85 mm Hg , as measured by ABPM between 10 AM and 8 PM , were r and omized to 12 weeks of active treatment with irbesartan or enalapril . Starting doses were 150 and 10 mg/d , respectively , with titration to 300 or 20 mg/d if clinic DBP was > or = 90 mm Hg at week 4 or 8 . Based on clinic measurements , BP control was defined as a BP reading < 140/90 mm Hg after 12 weeks of treatment ; patients achieving a reduction in DBP of > or = 10 mm Hg at 12 weeks were considered responders . The ABPM criterion for BP control , independent of clinic values , was achievement of a daytime BP < 130/85 mm Hg after 12 weeks of treatment ; patients achieving a reduction in 24-hour DBP > or = 5 mm Hg at 12 weeks were considered responders , in dependent of clinic values . RESULTS A total of 238 patients were r and omized to treatment , 115 to irbesartan and 123 to enalapril . The study population was approximately 52.0 % female and 48.0 % male , with a mean ( + /- SD ) age of 52.7 + /- 10.6 years . The study was completed by 111 patients in the irbesartan group ( dose titrated to 300 mg/d in 72.0 % of patients ) and 115 patients in the enalapril group ( dose titrated to 20 mg/d in 76.5 % of patients ) . BP reductions were similar in the 2 groups , both as measured in the clinic ( DBP , 12.7 + /- 8.8 mm Hg irbesartan vs 12.4 + /- 7.4 mm Hg enalapril ; SBP , 19.0 + /- 14.1 mm Hg vs 17.5 + /- 14.0 mm Hg ) and by 24-hour ABPM ( DBP , 9.4 + /- 8.5 mm Hg vs 8.8 + /- 8.5 mm Hg : SBP , 14.7 + /- 14.7 mm Hg vs 12.6 + /- 13.1 mm Hg ) . As assessed by ABPM , rates of BP control were 40.5 % ( 45/111 ) for irbesartan and 33.9 % ( 39/115 ) for enalapril , and the response rates were a respective 71.2 % ( 79/111 ) and 71.3 % (  
    Output:
    
Contribution This systematic review of trials that directly compared ACE inhibitors and ARBs in adults with essential hypertension found good evidence that the agents had similar long-term effects on blood pressure .
There were no consistent differential effects for mortality , cardiovascular events , progression to diabetes , left ventricular function , or kidney disease .
Cough was more frequent with ACE inhibitors than ARBs .
Implication Both ACE inhibitors and ARBs have similar effects on blood pressure and may not have differential effects on other clinical outcomes , although ACE inhibitors do cause cough more often than ARBs .
For example , ACE inhibitors do not entirely block production of angiotensin II because of other , unaffected converting enzymes .