***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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    Input: A r and omized controlled trial of an information and medical record booklet design ed to improve patient underst and ing and participation in the management of hypertension was conducted in six inner London general practice s. After one year there were no significant differences between the group who had received the booklets and the control group in mean systolic or diastolic blood pressure , but the study group scored significantly higher on knowledge about hypertension and its management . However , the difference between the two groups was small , possibly because both groups started with a high level of underst and ing about hypertension and its management . In addition , the mean diastolic blood pressure in the control group showed that the treatment provided was already satisfactory , and that there was little need for improvement . Nevertheless , the information booklet evaluated in this study provides health professionals with a highly acceptable method of informing the patient about hypertension and its management and could be used both in hospital and general practice The efficacy of self-recording of blood pressure in the management of hypertension was assessed in a r and omized clinical trial involving 140 persons who had been receiving antihypertensive therapy for a year or more , but whose diastolic blood pressure had remained at 95 mm Hg or higher . To control for the increased attention implicit in self-recording , which might affect blood pressure , the patients were assigned at r and om to one of the four groups : self-recording and monthly home visits , self-recording only , monthly home visits only , and neither self-recording nor monthly home visits . This design also permitted assessment of the effect of home visits . During the 6-month experiment no significant differences were apparent between the groups in either compliance or diastolic blood pressure . However , both self-recording and monthly home visits produced a reduction in blood pressure among patients who admitted to difficulty remembering to take their pills ; a reduction was not seen among patients who said they had no such difficulty . This confirmed an earlier observation suggesting that this easily identified group of patients may be the most responsive to intervention programs OBJECTIVE --Audit of detection , treatment , and control of hypertension in adults in Scotl and . DESIGN --Cross sectional survey with r and om population sampling . SETTING --General practice centres in 22 Scottish districts . SUBJECTS--5123 Men and 5236 women aged 40 - 59 in the Scottish heart health study , r and omly selected from 22 districts throughout Scotl and , of whom 1262 men and 1061 women had hypertension ( defined as receiving antihypertensive treatment or with blood pressure above defined cut off points ) . MAIN OUTCOME MEASURE -- Hypertension ( assessed by st and ardised recording , question naire on diagnosis , and antihypertensive drug treatment ) according to criteria of the World Health Organisation ( receiving antihypertensive treatment or blood pressure greater than or equal to 160/95 mm Hg , or both ) and to modified criteria of the British Hypertension Society . RESULTS --In half the men with blood pressure greater than or equal to 160/95 mm Hg hypertension was undetected ( 670/1262 , 53 % ) , in half of those in whom it had been detected it was untreated ( 250/592 , 42 % ) , and in half of those receiving treatment it was not controlled ( 172/342 , 50 % ) . In women the numbers were : 486/1061 , 46 % ; 188/575 , 33 % ; and 155/387 , 40 % respectively . Assessment of blood pressure according to the British Hypertension Society 's recommendations showed an improvement , but in only a quarter of men and 42 % of women was hypertension detected and treated satisfactorily ( 142/561 , 215/514 respectively ) . IMPLICATION S -- The detection and control of hypertension in Scotl and is unsatisfactory , affecting management of this and other conditions , such as high blood cholesterol concentration , whose measurement is opportunistic and selective and depends on recognition of other risk factors Home measurement of blood pressure ( BP ) can improve compliance . The aim of this study was to evaluate if the efficacy of losartan in hypertension could be enhanced by providing patients with a device for home BP measurement . In this open , r and omised , prospect i ve , multi-centre study in 244 Swiss practice s , patients with mild-to-moderate hypertension were r and omised to a group receiving a home BP measuring device ( OMRON ) ( group 2 ) , or to a group where this device was not provided ( group 1 ) . After 8 weeks of treatment with losartan , the responder rates between subjects performing home measurement of BP were compared with those without self-measurement , whereby exclusively sphygmomanometric office BP values were considered . A total of 622 subjects completed the study . Treatment with losartan significantly reduced diastolic ( DBP ) and systolic BP ( SBP ) ( P < 0.0001 ) . overall , the group with home bp measurement showed an increased responder rate ( dbp ⩽90 mm hg ) by 6.4 % ( 59.8 % vs 66.2 % ; 0.05 < P < 0.1 ) . this difference was mainly due to female patients ( 64.1 % vs 73.2 % ) , where it reached statistical significance ( P < 0.01 ) . pretreated patients showed a 9.0 % improvement of response in the home measurement group as well ( 0.05 < P < 0.1 ) . the responder rate in newly treated subjects was relatively high , reaching 79.5 % ( dbp ⩽90 mm hg or reduction ⩾10 mm Hg DBP from baseline ) . However , home measurement did not significantly improve BP control in these new patients ( 81.4 % vs 77.7 % ) . Overall , home measurement can lead to a slight improvement of BP control . This improvement was most evident in females , reaching significance BACKGROUND In the future , primary care groups ( PCGs ) will have to consider how best to apply audit and education to fulfil their commitment to clinical governance and to facilitate the implementation of research findings . AIM To establish whether an exploration of ' barriers to change ' can enhance the effectiveness of an educational intervention design ed to improve the management of hypertension in the elderly . METHOD A parallel-arm , r and omized , single-blind , controlled trial of practice -based educational visits in 18 practice s. These practice s had previously taken part in a multi practice audit of the management of hypertension in the elderly . Both groups received outreach visits in their own practice , during which they received the results of the previous audit . The nine ' intervention ' practice s were encouraged to explore barriers that would prevent them from implementing pertinent research findings . The control group was not encouraged to do this . The main outcome measure of the trial was determined in advance as ' the stated management of systolic hypertension in patients aged 70 to 79 ' . A secondary endpoint was the stated management of a specific patient scenario . The endpoints were tested by question naire before and after the educational intervention . RESULTS For the primary endpoint , there was a statistically significant difference in the stated threshold for treating systolic hypertension between intervention and control groups after the visits ( 161.8 mmHg versus 167.2 mmHg ; P = 0.007 ) . For the secondary endpoint , there was also a statistically significant difference between the two groups , after the visits , in their willingness to treat a 70-year-old male with mild hypertension  ( 89 % of doctors would treat in the intervention group versus 57 % in the control group ; P = 0.047 ) . CONCLUSION The effectiveness of an educational intervention is significantly improved by addressing the barriers preventing practitioners from implementing the findings of research BACKGROUND St and ard office-based approaches to controlling hypertension show limited success . Such suboptimal hypertension control reflects in part the absence of both an infrastructure for patient education and frequent , regular blood pressure ( BP ) monitoring . We tested the efficacy of a physician-directed , nurse-managed , home-based system for hypertension management with st and ardized algorithms to modulate drug therapy , based on patients ' reports of home BP . METHODS We r and omized out patients requiring drug therapy for hypertension according to the Joint National Committee on Prevention , Detection , Evaluation , and Treatment of High Blood Pressure ( JNC VI ) criteria to receive usual medical care only ( UC , n = 76 ) or usual care plus nurse care management intervention ( INT , n = 74 ) over a 6-month period . RESULTS Patients receiving INT achieved greater reductions in office BP values at 6 months than those receiving UC : 14.2 + /- 18.1 versus 5.7 + /- 18.7 mm Hg systolic ( P < .01 ) and 6.5 + /- 10.0 versus 3.4 + /- 7.9 mm Hg diastolic , respectively ( P < .05 ) . At 6 months , we observed one or more changes in drug therapy in 97 % of INT patients versus 43 % of UC patients , and 70 % of INT patients received two or more drugs versus 46 % of UC . Average daily adherence to medication , measured by electronic drug event monitors , was superior among INT subjects ( mean + /- SD , 80.5 % + /- 23.0 % ) than among UC subjects ( 69.2 + /- 31.1 % ; t(113 ) = 2.199 , P = .03 ) . There were no significant adverse drug reactions in either group . CONCLUSIONS Telephone-mediated nurse management can successfully address many of the systems-related and patient-related issues that limit pharmacotherapeutic effectiveness for hypertension The effectiveness of a quality improvement program for hypertension management practice s and patient health outcomes in a group-model managed care organization was evaluated . Health-system pharmacists analyzed medical and pharmacy cl aims data to identify hypertensive patients . Chart review was conducted on a r and om sample of these patients to vali date a hypertension diagnosis and to obtain blood pressure ( BP ) control rates and prevalence of cardiovascular risk factors and comorbid conditions . The interventions consisted of educating health care providers and recommending appropriate pharmacotherapy for compelling indications . Patient outcomes were compared with baseline hypertension data . After interventions were implemented , medical and pharmacy cl aims identified 30,721 hypertensive patients and chart review s were performed on a r and om sample of 417 patients . Pharmacy cl aims revealed a total of 193,311 antihypertensive prescriptions . Approximately 47 % of all hypertensive patients were managed with monotherapy , while 24 % received dual therapy , and 11 % were taking three or more antihypertensive medications per day . Of the patients on monotherapy , 93 % received an angiotensin-converting-enzyme inhibitor ( 27.3 % ) , diuretic ( 26.6 % ) , beta-blocker ( 23.4 % ) , or calcium channel blocker ( 15.4 % ) . The overall level of BP control significantly improved from 37.2 % at baseline to 49.2 % at follow-up ( p = 0.0007 ) . BP control in the follow-up evaluation was 22.2 % in diabetic patients . For treatment of patients with comorbid disease states , provider practice patterns were evaluated at baseline and follow-up . Improving the quality of hypertension management increased BP control from 37.2 % to 49.2 % . Continued efforts to improve hypertension management , particularly in patients with concomitant diabetes and in elderly patients with isolated systolic hypertension , are needed CONTEXT Self-measurement of blood pressure is increasingly used in clinical practice , but how it affects the treatment of hypertension requires further study . OBJECTIVE To compare use of  blood pressure ( BP ) measurements taken in physicians ' offices and at home in the treatment of patients with hypertension . DESIGN , SETTING , AND PARTICIPANTS Blinded r and omized controlled trial conducted from March 1997 to April 2002 at 56 primary care practice s and 3 hospital-based outpatient clinics in Belgium and 1 specialized hypertension clinic in Dublin , Irel and . Four hundred participants with a diastolic BP ( DBP ) of 95 mm Hg or more as measured at physicians ' offices were enrolled and followed up for 1 year . INTERVENTIONS Antihypertensive drug treatment was adjusted in a stepwise fashion based on either the self-measured DBP at home ( average of 6 measurements per day during 1 week ; n = 203 ) or the average of 3 sitting DBP readings at the physician 's office ( n = 197 ) . If the DBP guiding treatment was above ( > 89 mm Hg ) , at ( 80 - 89 mm Hg ) , or below ( < 80 mm Hg ) target , a physician blinded to r and omization intensified antihypertensive treatment , left it unchanged , or reduced it , respectively . MEAN OUTCOME MEASURES Office and home BP levels , 24-hour ambulatory BP , intensity of drug treatment , electrocardiographic and echocardiographic left ventricular mass , symptoms reported by question naire , and costs of treatment . RESULTS At the end of the study ( median follow-up , 350 days ; interquartile range , 326 - 409 days ) , more home BP than office BP patients had stopped antihypertensive drug treatment ( 25.6 % vs 11.3 % ; P<.001 ) with no significant difference in the proportions of patients progressing to multiple-drug treatment ( 38.7 % vs 45.1 % ; P = .14 ) . The final office , home , and 24-hour ambulatory BP measurements were higher ( P<.001 ) in the home BP group than in the office BP group . The mean baseline-adjusted systol 
    Output:
    
RCTs of educational interventions directed at patients or health professionals were heterogeneous but appeared unlikely to be associated with large net reductions in blood pressure by themselves .