***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: A substantial number of older hypertensive patients have stage 1 isolated systolic hypertension ( systolic blood pressure between 140 and 159 mm Hg and diastolic blood pressure < 90 mm Hg ) , but there are currently no data showing that drug treatment is effective , safe , and /or beneficial . To compare the effects of active treatment compared with placebo on blood pressure , left ventricular hypertrophy , and quality of life among older stage 1 isolated systolic hypertensive patients , a r and omized , double-blind , parallel-group , multicenter clinical trial comparing felodipine ( 2.5 , 5 , or 10 mg once daily ) and matching placebo was performed in 171 patients ( 49 % male , average age 66±7 years , with 49 % white and 30 % Hispanic ) with a baseline blood pressure of 149±7/83±6 mm Hg . During 52 weeks of treatment , patients r and omized to active treatment achieved significantly lower blood pressures ( 137.0±11.7/80.2±7.6 mm Hg for extended-release felodipine versus 147.5±16.0/83.5±9.7 mm Hg for placebo , P < 0.01 for each ) , a reduced incidence of left ventricular hypertrophy ( 7 % for extended release felodipine versus 24 % for placebo , P < 0.04 ) , and improved quality of life ( change in Psychological General Well-Being index , 3.0±6.8 for extended-release felodipine versus −0.8±10.3 for placebo , P < 0.01 ) versus baseline . There were no clinical ly significant differences between treatments in tolerability or adverse effects . Stage 1 isolated systolic hypertension can be effectively and safely treated pharmacologically . Treatment reduced progression to the higher stages of hypertension , reduced the incidence of left ventricular hypertrophy , and improved an overall measure of the quality of life . Larger and longer studies will be needed to document any long-term reduction in cardiovascular event rates associated with treating stage 1 systolic hypertension Although the benefits of antihypertensive treatment in " young " elderly ( under 70 years ) hypertensive patients are well established , the value of treatment in older patients ( 70 - 84 years ) is less clear . The Swedish Trial in Old Patients with Hypertension ( STOP-Hypertension ) was a prospect i ve , r and omised , double-blind , intervention study set up to compare the effects of active antihypertensive therapy ( three beta-blockers and one diuretic ) and placebo on the frequency of fatal and non-fatal stroke and myocardial infa rct ion and other cardiovascular death in hypertensive Swedish men and women aged 70 - 84 years . We recruited 1627 patients at 116 health centres throughout Sweden , who were willing to participate , and who met the entry criteria of three separate recordings during a 1-month placebo run-in period of systolic blood pressure between 180 and 230 mm Hg with a diastolic pressure of at least 90 mm Hg , or a diastolic pressure between 105 and 120 mm Hg irrespective of the systolic pressure . The total duration of the study was 65 months and the average time in the study was 25 months . 812 patients were r and omly allocated active treatment and 815 placebo . The mean difference in supine blood pressure between the active treatment and placebo groups at the last follow-up before an endpoint , death , or study termination was 19.5/8.1 mm Hg . Compared with placebo , active treatment significantly reduced the number of primary endpoints ( 94 vs 58 ; p = 0.0031 ) and stroke morbidity and mortality ( 53 vs 29 ; p = 0.0081 ) . Although we did not set out to study an effect on total mortality , we also noted a significantly reduced number of deaths in the active treatment group ( 63 vs 36 ; p = 0.0079 ) . The benefits of treatment were discernible up to age 84 years . We conclude that antihypertensive treatment in hypertensive men and women aged 70 - 84 confers highly significant and clinical ly relevant reductions in cardiovascular morbidity and mortality as well as in total mortality BACKGROUND Stevioside , a natural glycoside isolated from the plant Stevia rebaudiana Bertoni , has been used as a commercial sweetening agent in Japan and Brazil for > 20 years . Previous animal and human studies have indicated that stevioside has an antihypertensive effect . OBJECTIVES This study was undertaken to investigate the long-term ( 2-year ) efficacy and tolerability of stevioside in patients with mild essential hypertension . Secondary objectives were to determine the effects of stevioside on left ventricular mass index ( LVMI ) and quality of life ( QOL ) . METHODS This was a multicenter , r and omized , double-blind , placebo-controlled trial in Chinese men and women aged between 20 and 75 years with mild essential hypertension ( systolic blood pressure [ SBP ] 140 - 159 mm Hg and diastolic blood pressure [ DBP ] 90 - 99 mm Hg ) . Patients took capsules containing 500 mg stevioside powder or placebo 3 times daily for 2 years . Blood pressure was measured at monthly clinic visits ; patients were also encouraged to monitor blood pressure at home using an automated device . LVMI was determined by 2-dimensional echocardiography at baseline and after 1 and 2 years of treatment . QOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey . Electrocardiographic , laboratory , and QOL parameters were assessed at the beginning of treatment , and at 6 months , 1 year , and 2 years . RESULTS One hundred seventy-four patients ( 87 men , 87 women ) were enrolled in the study , and 168 completed it : 82 ( 42 men , 40 women ; mean [ SD ] age , 52 [ 7 ] years ) in the stevioside group and 86 ( 44 women , 42 men ; mean age , 53 [ 7 ] years ) in the placebo group . After 2 years , the stevioside group had significant decreases in mean ( SD ) SBP and DBP compared with baseline ( SBP , from 150 [ 7.3 ] to 140 [ 6.8 ] mm Hg ; DBP , from 95 [ 4.2 ] to 89 [ 3.2 ] mm Hg ; P < 0.05 ) and compared with placebo ( P < 0.05 ) . Based on patients ' records of self-monitored blood pressure , these effects were noted beginning approximately 1 week after the start of treatment and persisted throughout the study . There were no significant changes in body mass index or blood biochemistry , and the results of laboratory tests were similar in the 2 groups throughout the study . No significant difference in the incidence of adverse effects was noted between groups , and QOL scores were significantly improved overall with stevioside compared with placebo ( P < 0.001 ) . Neither group had a significant change in mean LVMI . However , after 2 years , 6 of 52 patients ( 11.5 % ) in the stevioside group had left ventricular hypertrophy ( LVH ) , compared with 17 of 50 patients ( 34.0 % ) in the placebo group ( P < 0.001 ) . Of those who did not have LVH at baseline , 3 of 46 patients ( 6.5 % ) in the stevioside group had developed LVH after 2 years , compared with 9 of 37 patients ( 24.3 % ) in the placebo group ( P < 0.001 ) . CONCLUSIONS In this 2-year study in Chinese patients with mild hypertension , oral stevioside significantly decreased SBP and DBP compared with placebo . QOL was improved , and no significant adverse effects were noted Summary The Syst-Eur Trial is a concerted action of the European Community ’s Medical and Health Research Programme . The trial is carried out in consultation with the World Health Organization , the International Society of Hypertension , the European Society of Hypertension and the World Hypertension League . This article describes the objectives and the protocol of Syst-Eur , a multicentre trial design ed by the European Working Party on High Blood . Pressure in the Elderly ( EWPHE ) , to test the hypothesis that antihypertensive treatment of elderly patients with isolated systolic hypertension results in a significant change in stroke morbidity and mortality . Secondary endpoints include cardiovascular events , such as myocardial infa rct ion and congestive heart failure .  To be eligible patients must be at least 60 years old and have a systolic blood pressure averaging 160–219 mmHg with a diastolic pressure less than 95 mmHg . Patients must give their informed consent and be free of major cardiovascular and non-cardiovascular diseases at entry . The patients are r and omized to active treatment or placebo . Active treatment consists of nitrendipine ( 10–40 mg/day ) , combined with enalapril ( 5–20 mg/day ) and hydrochlorothiazide ( 12.5–25 mg/day ) , as necessary . The patients of the control group receive matching placebos . The drugs ( or matching placebos ) are stepwise titrated and combined in order to reduce systolic blood pressure by 20 mmHg at least to a level below 150 mmHg . Morbidity and mortality are monitored to enable an intention-to-treat and per protocol comparison of the outcome in the 2 treatment groups . A one-year pilot trial ( 1989 ) showed that the protocol is practicable . The Ethics Committee therefore decided to start the definite study ( 1990 ) , in which r and omized patients will be followed for 5 years . Recruitment of new centres and of the required 3,000 patients will last 3 years ( until 1993 ) Objective To compare quality of life in elderly patients with isolated systolic hypertension allocated r and omly to groups to receive placebo or active treatment in the Systolic Hypertension in the Elderly Trial . Design Double-blind r and omized controlled trial . Methods Patients aged 60 years were allocated r and omly to groups to receive first-line treatment with nitrendipine ( with second- and third-line enalapril and hydrochlorothiazide ) or placebo . Trained interviewers administered trail-making tests ( Trail A and B ) , Brief Assessment Index ( a measure of depressed mood ) and four subscales from the Sickness Impact Profile ( Ambulation , Social Interaction , Sleep and Rest , and Home work ) . Results Six hundred and ten patients completed a baseline and at least one follow-up question naire . Trail-making scores were slower in actively treated patients , especially in the first 6 months of follow-up when the between-group effect sizes were 0.25 [ 95 % confidence interval ( CI ) 0.07 to 0.43 ] for Trail-making A and 0.13 ( 95 % CI −0.05 to 0.31 ) for Trail-making B. Across the 4 years of follow-up , patients receiving active treatment were more likely to report problems on the Social Interaction scale than were placebo-treated patients ( odds ratio 1.32 , 95 % CI 1.02 to 1.69 ) , equivalent to a 7 % difference . There were no significant differences between active and placebo treatment in the other Sickness Impact Profile dimensions or in the measure of depression .  Conclusions Active treatment in the Systolic Hypertension in Europe trial was associated with some small adverse impacts on quality of life BACKGROUND Results of previous studies of white older adults suggest that antihypertensive medications preserve cognition . We assessed the long-term effect of antihypertensive medications on cognitive function in a community sample of African American older adults . METHODS We conducted longitudinal surveys and clinical assessment of cognitive function in a r and om sample of 2212 community-dwelling African Americans 65 years and older . We identified 1900 participants without evidence of cognitive impairment at baseline , 1617 of whom had subsequent follow-up information , and 946 of whom had blood pressure measurements .  Cognitive function was measured at baseline and at 2 and 5 years by means of scores on the Community Screening Instrument for Dementia and neuropsychological and clinical assessment for dementia and cognitive impairment . Prescription and nonprescription medication use was derived from in-home inspection of medications and participant and informant reports . RESULTS Of 1900 participants , 288 ( 15.2 % ) developed incident cognitive impairment . Using logistic regression to control for the effects of age , sex , education , baseline cognitive scores , and hypertension and angina or myocardial infa rct ion , we found that antihypertensive medications reduced the odds of incident cognitive impairment by 38 % ( odds ratio , 0.62 ; 95 % confidence interval , 0.45 - 0.84 ) . Corresponding analysis using blood pressure measurements on the subset of participants was inconclusive . CONCLUSION Antihypertensive medication use is associated with preservation of cognitive function in older African American adults The Study on COgnition and Prognosis in the Elderly ( SCOPE ) was a multinational , r and omised , double-blind study to assess the effects of c and esartan 8–16 mg daily on cardiovascular events and cognitive function in elderly patients ( aged 70–89 years ) with mild to moderate hypertension . A total of 4937 patients were r and omised to c and esartan or placebo  with other  antihypertensive drugs 
    Output:
    
There was no convincing evidence from the trials identified that blood pressure lowering prevents the development of dementia or cognitive impairment in hypertensive patients with no apparent prior cerebrovascular disease .