***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: BACKGROUND Recent reports have drawn attention to the importance of pulse pressure as a predictor of cardiovascular events .  Pulse pressure is used neither by clinicians nor by guidelines to define treatable levels of blood pressure . METHODS In the Cardiovascular Health Study , 5888 adults 65 years and older were recruited from 4 US centers . At baseline in 1989 - 1990 , participants underwent an extensive examination , and all subsequent cardiovascular events were ascertained and classified . RESULTS At baseline , 1961 men and 2941 women were at risk for an incident myocardial infa rct ion or stroke . During follow-up that averaged 6.7 years , 572 subjects had a coronary event , 385 had a stroke , and 896 died . After adjustment for potential confounders , systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP ) , and pulse pressure were directly associated with the risk of incident myocardial infa rct ion and stroke . Only SBP was associated with total mortality . Importantly , SBP was a better predictor of cardiovascular events than DBP or pulse pressure . In the adjusted model for myocardial infa rct ion , a 1-SD change in SBP , DBP , and pulse pressure was associated with hazard ratios ( 95 % confidence intervals ) of 1.24 ( 1.15 - 1.35 ) , 1.13 ( 1.04 - 1.22 ) , and 1.21 ( 1.12 - 1.31 ) , respectively ; and adding pulse pressure or DBP to the model did not improve the fit . For stroke , the hazard ratios ( 95 % confidence intervals ) were 1.34 ( 1.21 - 1.47 ) with SBP , 1.29 ( 1.17 - 1.42 ) with DBP , and 1.21 ( 1.10 - 1.34 ) with pulse pressure . The association between blood pressure level and cardiovascular disease risk was generally linear ; specifically , there was no evidence of a J-shaped relationship . In those with treated hypertension , the hazard ratios for the association of SBP with the risks for myocardial infa rct ion and stroke were less pronounced than in those without treated hypertension . CONCLUSION In this population -based study of older adults , although all measures of blood pressure were strongly and directly related to the risk of coronary and cerebrovascular events , SBP was the best single predictor of cardiovascular events The effect of conventional propranolol and bendrofluazide tablets given twice daily has been compared with an equivalent dosage combined in a single capsule given twice daily in fourteen patients with essential hypertension .  Good blood pressure control was achieved on both regimes in the majority of patients and there was no significant difference in treatment response between the two regimes . Use of the combined capsule is convenient and may improve patient compliance BACKGROUND Short-term studies have suggested that the use of initial combination therapy for the control of blood pressure improves early effectiveness . We tested whether a combination of aliskiren and amlodipine is superior to each monotherapy in early control of blood pressure without excess of adverse events , and if initial control by monotherapy impairs subsequent control by combination therapy . METHODS We did a double-blind , r and omised , parallel-group , superiority trial at 146 primary and secondary care sites in ten countries , with enrolment from Nov 28 , 2008 , to July 15 , 2009 . Patients eligible for enrolment had essential hypertension , were aged 18 years or older , and had systolic blood pressure between 150 and 180 mm Hg . Patients were r and omly assigned ( 1:1:2 ) to treatment with 150 mg aliskiren plus placebo , 5 mg amlodipine plus placebo , or 150 mg aliskiren plus 5 mg amlodipine . R and om assignment was through a central interactive voice response system and treatment allocation was masked from the patients . From 16 - 32 weeks , all patients received combination therapy with 300 mg aliskiren plus 10 mg amlodipine . Our primary endpoints , assessed on an intention-to-treat basis ( ie , in patients who received the allocated treatment ) , were the adjusted mean reduction in systolic blood pressure from baseline over 8 to 24 weeks , and then the final reduction at 24 weeks . This trial is registered with Clinical Trials.gov , number NCT00797862 . FINDINGS 318 patients were r and omly assigned to aliskiren , 316 to amlodipine , and 620 to aliskiren plus amlodipine . 315 patients initially allocated to aliskiren , 315 allocated to amlodipine , and 617 allocated to aliskiren plus amlodipine were available for analysis . Patients given initial combination therapy had a 6·5 mm Hg ( 95 % CI 5·3 to 7·7 ) greater reduction in mean systolic blood pressure than the monotherapy groups ( p<0·0001 ) . At 24 weeks , when all patients were on combination treatment , the difference was 1·4 mm Hg ( 95 % CI -0·05 to 2·9 ; p=0·059 ) . Adverse events caused withdrawal of 85 patients ( 14 % ) from the initial aliskiren plus amlodipine group , 45 ( 14 % ) from the aliskiren group , and 58 ( 18 % ) from the amlodipine  group . Adverse events were peripheral oedema , hypotension , or orthostatic hypotension . INTERPRETATION We believe that routine initial reduction in blood pressure ( > 150 mm Hg ) with a combination such as aliskiren plus amlodipine can be recommended . FUNDING Novartis Pharma AG ABSTRACT Objective : Free combination hypertension medication is associated with a lower compliance and less persistence compared to fixed combination therapy and can , therefore , be associated with insufficient blood pressure reductions . This non-r and omized study investigated whether valsartan 160 mg/ hydrochlorothiazide 25 mg ( Val 160/HCTZ 25 ) in fixed dose combination could provide additional blood pressure control in hypertensive patients not adequately controlled by the free combination of c and esartan 32 mg plus HCTZ 25 mg . Research design and methods : One hundred and ninety-seven patients with a mean sitting diastolic blood pressure ( MSDBP ) between 100 and 110 mmHg entered a 4-week treatment phase with 32 mg of c and esartan in free combination with 25 mg of HCTZ once daily . One hundred and thirty-eight patients with uncontrolled BP at Week 4 , entered a second 4-week treatment phase with Val160/ HCTZ 25 once daily . Main outcome measures : The primary efficacy parameter was the reduction in MSDBP at trough between Week 4 and Week 8 in the intent-to-treat population . Results : At baseline , MSDBP was 103.0 ± 2.8 mmHg . After Week 4 , MSDBP had decreased to 93.8 ± 4.5 mmHg . Subsequent treatment with Val 160/HCTZ 25 for 4 weeks reduced MSDBP to 88.7 ± 8.6 mmHg . This represented an additional decrease in MSDBP of 5.1 ± 7.9 mmHg ( p < 0.0001 ) . Val 160/ HCTZ 25 reduced mean sitting systolic BP by 3.4 ± 13.0 mmHg ( p = 0.0029 ) . Conclusions : The fixed dose combination of valsartan 160/HCTZ 25 mg provided a statistically and clinical ly significant additional BP reduction in patients not controlled by the free combination of c and esartan 32 mg and HCTZ 25 mg The importance of number of tablets for patient compliance was investigated in 160 patients with mild-moderate essential hypertension treated with a beta-adrenoceptor blocker and a thiazide diuretic . Mean BP at entry 146 + /- 16/92 + /- 8 mm Hg . All patients were given pindolol 10 mg and clopamide 5 mg in one combination tablet or in separate tablets for 4 months respectively . Approximately 90 % of the patients took greater than 90 % of the prescribed dose throughout the study . Mean BP decreased progressively and heart rate increased slightly . Side effects were more frequently reported during the first month of the study than previously , and 30 patients discontinued the treatment . No differences in this respect were seen between 1 and 2 tablets daily . Approximately 75 % of the patients preferred 1 tablet daily , but combining two drugs in one tablet had no effect upon compliance OBJECTIVES To assess medication adherence , persistence , and costs between cohorts of patients in managed care setting s using a fixed-dose combination ( FDC ) or individual components ( IC ) of valsartan and hydrochlorothiazide  in an insurance cl aims data base . METHODS Medical and prescription cl aims for hypertensive patients using a combination of valsartan and HCTZ were identified from the IHCIS National Managed Care Benchmark Data base via a retrospective cohort analysis . Study subjects had at least 110 days prior to start of study medications during which no other antihypertensive medications were prescribed , and were followed for 12 months . Cl aims for 8711 adult patients were analyzed for adherence , persistence and costs . General linear regression was conducted to detect differences in adherence among groups . Covariates included age , gender , persistence , number on concomitant cardiovascular drugs , and number of cardiovascular diagnoses . RESULTS Most subjects used an FDC product ( N=8150 , 93.6 % ) vs. the IC ( N=561 , 6.4 % ) . The FDC group had a larger portion of males and less concomitant cardiovascular medications or disease . A r and om sample of 1628 of the FDC subjects had improved values for medication adherence compared to the IC group ( 62.1 vs. 53.0 % , p<0.001 ) and persistence values were improved at both 180 days ( 73 vs. 28 % , p<0.001 ) and 365 days ( 54 vs. 19 % , p<0.001 ) . Both prescription drug costs ( $ 1587 vs. $ 2050 , p<0.001 ) and medical costs ( $ 3343 vs. $ 3817 , p<0.001 ) were lower in the FDC cohorts . CONCLUSIONS The use of fixed-dose therapy in hypertension may lead to increased adherence and persistence with a positive financial impact on both prescription and total medical costs . As with any retrospective cl aims data base analysis , unobserved systematic differences between the two medication groups may exist Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists Background and Purpose — The benefits of antihypertensive ( AH ) drugs on the risks of major cardiovascular outcomes have been demonstrated in clinical trials . However , approximately half of hypertensive patients do not adhere well to their prescribed AH therapy in actual practice . The purpose of this study was to assess the impact of adherence to AH agents on the incidence of cerebrovascular disease ( CD ) in real-world practice . Methods — A cohort of 83 267 hypertensive patients was reconstructed from the Régie de l'assurance maladie du Québec data bases . Subjects included were between 45 and 85 years old , initially free of cardiovascular disease , and newly treated for hypertension with AH agents between 1999 and 2004 . A nested case – control design was conducted to study CD occurrence . Every case was matched for age and duration of follow-up with up to 15 r and omly selected control subjects . The adherence to AH drugs  was measured by calculating the medication possession ratio . Conditional logistic regression models were performed to assess the association between adherence to AH agents and CD adjusting for various potential confounders . Results — At cohort entry , the mean patient age was 65 years , 37.3 % were male , 8.6 % had diabetes , and 19.5 % had dyslipidemia . High adherence ( ≥80 % ) to AH drugs significantly decreased the risk of CD by 22 % ( rate ratio , 0.78 ; 95 % CI , 0.70 to 0.87 ) compared with lower adherence 
    Output:
    
For endpoints correlated with higher adherence ( e.g. , a reduction in blood pressure ) , a nonsignificant benefit was observed for FDCs .
Moreover , it was demonstrated that higher adherence can lead to a lower risk of cardiovascular events .
Conclusions In comparison with FECs , the FDC treatment is associated with a significant improvement in the cooperation between a doctor and a patient and with increased patients ' adherence to the treatment schedule