***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: The number of published systematic review s of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions . Systematic review s are subject to a range of biases and increasingly include non-r and omised studies of interventions . It is important that users can distinguish high quality review s. Many instruments have been design ed to evaluate different aspects of review s , but there are few comprehensive critical appraisal instruments . AMSTAR was developed to evaluate systematic review s of r and omised trials . In this paper , we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic review s that include r and omised or non-r and omised studies of healthcare interventions , or both . With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic review s , including those based on non-r and omised studies of healthcare interventions Obesity , metabolic syndrome , dyslipidemia , and poor quality of life are common conditions associated with hypertension , and incidence of hypertension is age dependent . However , an effective program to prevent hypertension and to improve biomedical factors and quality of life has not been adequately examined or evaluated in Chinese older adults . This study aims to examine the effectiveness of a Tai Chi program to improve health status in participants with hypertension and its related risk factors such as dyslipidemia , hyperglycemia , and quality of life in older adults in China . A r and omized study design was used . At the conclusion of the intervention , 266 patients remained in the study .  Blood pressure and biomedical factors were measured according to the World Diabetes Association st and ard 2002 . A st and ardized quality -of-life measure was used to measure health-related quality of life . It was found that a Tai Chi program to improve hypertension in older adults is effective in reducing blood pressure and body mass index , maintaining normal renal function , and improving physical health of health-related quality of life . It did not improve existing metabolic syndrome levels , lipid level ( dyslipidemia ) or fasting glucose level ( hyperglycemia ) , to prevent further deterioration of the biomedical risk factors . In conclusion , Tai Chi is effective in managing a number of risk factors associated with hypertension in Chinese older adults . Future research should examine a combination of Tai Chi and nutritional intervention to further reduce the level of biomedical risks Objectives . To assess the current clinical evidence of Tai Chi for essential hypertension ( EH ) . Search Strategy . 7 electronic data bases were search ed until 20 April , 2013 . Inclusion Criteria . We included r and omized trials testing Tai Chi versus routine care or antihypertensive drugs . Trials testing Tai Chi combined with antihypertensive drugs versus antihypertensive drugs were also included . Data Extraction and Analyses . Study selection , data extraction , quality assessment , and data analyses were conducted according to the Cochrane st and ards . Results . 18 trials were included . Method ological quality of the trials was low . 14 trials compared Tai Chi with routine care . 1 trial compared Tai Chi with antihypertensive drugs . Meta- analysis all showed significant effect of TaiChi in lowering blood pressure ( BP ) . 3 trials compared Tai Chi plus antihypertensive drugs with antihypertensive drugs . Positive results in BP were found in the other 2 combination groups . Most of the trials did not report adverse events , and the safety of Tai Chi is still uncertain . Conclusions . There is some encouraging evidence of Tai Chi for EH . However , due to poor method ological quality of included studies , the evidence remains weak . Rigorously design ed trials are needed to confirm the evidence OBJECTIVES To evaluate the effects on blood pressure , lipid profile , and anxiety status on subjects received a 12-week Tai Chi Chuan exercise program . DESIGN R and omized controlled study of a Tai Chi Chuan group and a group of sedentary life controls . SETTING Taipei Medical University Hospitals and University campus in the Taipei , Taiwan , area . SUBJECTS Two ( 2 ) selected groups of 76 healthy subjects with blood pressure at high-normal or stage I hypertension . INTERVENTION A 12-week Tai Chi Chuan exercise training program was practice d regularly with a frequency of 3 times per week . Each session included 10-minute warm-up , 30-minute Tai Chi exercise , 10-minute cool-down . Exercise intensity was estimated to be approximately 64 % of maximal heart rate . OUTCOME MEASURES Blood pressure , lipid profile and anxiety status ( State-Trait Anxiety Inventory ; STAI ) were evaluated . RESULTS After 12-weeks of Tai Chi training , the treatment group showed significant decrease in systolic blood pressure of 15.6 mm Hg and diastolic blood pressure 8.8 mm Hg . The serum total cholesterol level decreased 15.2 mg/dL and high-density lipoprotein cholesterol increased 4.7 mg/dL. By using STAI evaluation , both trait anxiety and state anxiety were decreased . CONCLUSIONS This study shows that under well- design ed conditions , Tai Chi exercise training could decrease blood pressure and results in favorable lipid profile changes and improve subjects ' anxiety status . Therefore , Tai Chi could be used as an alternative modality in treating patients with mild hypertension , with a promising economic effect Objectives : To test the effects of group‐based Tai chi on health‐status outcomes among older adults with hypertension . Background : A high‐ quality study exploring the effects of Tai chi on physical and psychosocial health for older adults with hypertension is needed in China . The long‐term effects of group‐based Tai chi in Chinese older adults with hypertension remain unclear . Methods : A r and omized controlled trial was conducted . The group‐based Tai chi training and practice were implemented in older adults over six‐month . Results : The  Tai chi ( TC ) group showed significantly lower blood pressure and body mass index than the usual care ( UC ) group . The TC group participants showed greater improvements in social support , quality of life , and reduction in depressive symptoms over a six‐month intervention than UC group . TC group showed significant group‐by‐time interactions in these variables . Conclusion : Group‐based Tai chi is effective in the enhancement of health‐status outcomes for older Chinese adults with hypertension IMPORTANCE Hypertension is the most important preventable cause of morbidity and mortality globally , yet there are relatively few data collected using st and ardized methods . OBJECTIVE To examine hypertension prevalence , awareness , treatment , and control in participants at baseline in the Prospect i ve Urban Rural Epidemiology ( PURE ) study . DESIGN , SETTING , AND PARTICIPANTS A cross-sectional study of 153,996 adults ( complete data for this analysis on 142,042 ) aged 35 to 70 years , recruited between January 2003 and December 2009 . Participants were from 628 communities in 3 high-income countries ( HIC ) , 10 upper-middle-income and low-middle-income countries ( UMIC and LMIC ) , and 4 low-income countries ( LIC ) . MAIN OUTCOMES AND MEASURES Hypertension was defined as individuals with self-reported treated hypertension  or with an average of 2 blood pressure measurements of at least 140/90 mm Hg using an automated digital device . Awareness was based on self-reports , treatment was based on the regular use of blood pressure-lowering medications , and control was defined as individuals with blood pressure lower than 140/90 mm Hg . RESULTS Among the 142,042 participants , 57,840 ( 40.8 % ; 95 % CI , 40.5%-41.0 % ) had hypertension and 26,877 ( 46.5 % ; 95 % CI , 46.1%-46.9 % ) were aware of the diagnosis . Of those who were aware of the diagnosis , the majority ( 23,510 [ 87.5 % ; 95 % CI , 87.1%-87.9 % ] of those who were aware ) were receiving pharmacological treatments , but only a minority of those receiving treatment were controlled ( 7634 [ 32.5 % ; 95 % CI , 31.9%-33.1 % ] ) . Overall , 30.8 % , 95 % CI , 30.2%-31.4 % of treated patients were taking 2 or more types of blood pressure-lowering medications . The percentages aware ( 49.0 % [ 95 % CI , 47.8%-50.3 % ] in HICs , 52.5 % [ 95 % CI , 51.8%-53.2 % ] in UMICs , 43.6 % [ 95 % CI , 42.9%-44.2 % ] in LMICs , and 40.8 % [ 95 % CI , 39.9%-41.8 % ] in LICs ) and treated ( 46.7 % [ 95 % CI , 45.5%-47.9 % ] in HICs , 48.3 % , [ 95 % CI , 47.6%-49.1 % ] in UMICs , 36.9 % , [ 95 % CI , 36.3%-37.6 % ] in LMICs , and 31.7 % [ 95 % CI , 30.8%-32.6 % ] in LICs ) were lower in LICs compared with all other countries for awareness ( P < .001 ) and treatment ( P < .001 ) . Awareness , treatment , and control of hypertension were higher in urban communities compared with rural ones in LICs ( urban vs rural , P < .001 ) and LMICs ( urban vs rural , P < .001 ) , but similar for other countries . Low education was associated with lower rates of awareness , treatment , and control in LICs , but not in other countries . CONCLUSIONS AND RELEVANCE Among a multinational study population , 46.5 % of participants with hypertension were aware of the diagnosis , with blood pressure control among 32.5 % of those being treated . These findings suggest substantial room for improvement in hypertension diagnosis and treatment Background : Although the prevalence of hypertension ( HTN ) continues to increase in developing countries , including China , recent data are lacking . A nationwide survey was conducted from October 2012 to December 2015 to assess the prevalence of HTN in China . Methods : A stratified multistage r and om sampling method was used to obtain a nationally representative sample of 451 755 residents ≥18 years of age from 31 provinces in mainl and China from October 2012 to December 2015 .  Blood pressure ( BP ) was measured after resting for 5 minutes by trained staff using a vali date d oscillometric BP monitor .  HTN was defined as systolic BP ( SBP ) ≥140 mm Hg/or diastolic BP ( DBP ) ≥90 mm Hg or use of antihypertensive medication within 2 weeks . Pre-HTN was defined as SBP 120 to 139 mm Hg and DBP 80 to 89 mm Hg without antihypertensive medication  . HTN control was defined as SBP < 140 mm Hg and DBP<90 mm Hg . In addition , the prevalence of HTN ( SBP ≥130 or DBP ≥80 mm Hg ) and control rate ( SBP < 130 and DBP < 80 mm Hg ) of HTN were also estimated according to the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline . Results : Overall , 23.2 % ( ≈244.5 million ) of the Chinese adult population ≥18 years of age had HTN , and another 41.3 % ( ≈435.3 million ) had pre-HTN according to the Chinese guideline . There were no significant differences of HTN prevalence between urban and rural residents ( 23.4 % versus 23.1 % , P=0.819 ) . Among individuals with HTN , 46.9 % were aware of their condition , 40.7 % were taking prescribed antihypertensive medications , and 15.3 % had controlled HTN . Calcium channel blockers were the most commonly used antihypertensive medication ( 46.5 % ) as monotherapy , and 31.7 % of treated hypertensive patients used ≥2 medications . The prevalence of HTN based on the 2017 American College of Cardiology/American Heart Association guideline was twice as high as that based on 2010 Chinese guideline ( 46.4 % ) , whereas the control rate fell to 3.0 % . Conclusions : In China , there is a high prevalence of HTN and pre-HTN , and awareness , treatment , and control of HTN were low . Management of medical therapy for HTN needs to improve Hypertension is the most common condition seen in primary care and leads to myocardial infa rct ion , stroke , renal failure , and death if not detected early and treated appropriately . Patients want to be assured that blood pressure ( BP ) treatment will reduce their disease burden , while clinicians want guidance on hypertension management using the best scientific evidence . This report takes a rigorous , evidence -based approach to recommend treatment thresholds , goals , and medications in the management of hypertension in adults . Evidence was drawn from r and omized controlled trials , which represent the gold st and ard for determining efficacy and effectiveness . Evidence quality and recommendations were grade d based on their effect on important outcomes . There is strong evidence to support treating hypertensive persons aged 60 years or older to a  BP goal  of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than  
    Output:
    
Meta- analysis showed that , compared with health education/no treatment , other exercise or antihypertensive drugs ( AHD ) , Tai Chi showed statistically significant difference in lowering systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) .
The trial sequential analysis suggested that the evidence in our meta- analysis was reliable and conclusive .
Subgroup analyses of Tai Chi vs. AHD demonstrated Tai Chi for hypertension patients < 50 years old showed greater reduction in SBP and DBP .
Intervention of 12–24 weeks could significantly lower SBP and DBP .
Tai Chi could be recommended as an adjuvant treatment for hypertension , especially for patients less than 50 years old .