***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: Objective We aim ed to compare blood pressure ( BP ) levels recorded using the semiautomatic oscillometric Omron i-C10 BP device in patients with or without hypertension in three different setting s : ( a ) when used by a doctor or a nurse at the office ( OBP ) ; ( b ) when used for self-measurement by the patient at the office ( SMOBP ) ; and ( c ) when used for 7 consecutive days at home ( HBP ) . Material s and methods A total of 247 individuals were invited to participate , but 78 of these individuals declined and a further seven were excluded , leaving a final cohort of 162 participants . Results The mean OBP was higher than HBP ( difference 8.1±14/3.1±8.8 mmHg , P<0.0001 ) and so was SMOBP compared with HBP ( difference 7.0±13/4.2±7.3 mmHg , P<0.0001 ) . Sixteen participants ( 9.9 % ) had at least 10 mmHg higher systolic SMOBP than OBP and 28 ( 17 % ) participants had at least 10 mmHg lower systolic SMOBP than OBP . Participants who were current smokers had a larger mean difference between systolic OBP and SMOBP than nonsmokers ( OBP−SMOBP in smokers : 6.6±9.4 mmHg , OBP−SMOBP in nonsmokers : 0.5±9.2 mmHg , P=0.011 between groups ) . ConclusionS elf-measurement of BP in the office does not preclude an increase in BP when levels in the individual patients are compared with HBP using the same equipment . Thus , SMOBP with a semiautomatic device does not lead to a reduction in the white-coat effect in the same manner as fully automatic devices Recent publications have stated that the blood pressure ( BP )  measurement technique used in SPRINT ( Systolic Blood Pressure Intervention Trial ) was unattended . However , the SPRINT protocol does not address the issue of attendance . A survey was conducted immediately after SPRINT closeout visits were completed to inquire whether BP measurements were usually attended or unattended by staff . There were 4082 participants at 38 sites that measured BP after leaving the participant alone the entire time ( always alone ) , 2247 at 25 sites that had personnel in the room the entire time ( never alone ) , 1746 at 19 sites that left the  participant alone only  during the rest period ( alone for rest ) , and 570 at 6 sites that left the  participant alone only  during the BP readings ( alone for BP measurement ) . Similar systolic and diastolic BPs within r and omized groups were noted during follow-up at the majority of visits in all 4 measurement categories . In the always alone and never alone categories , the intensive group had a similarly reduced risk for the primary outcome compared with the st and ard group ( hazard ratio , 0.62 ; 95 % confidence interval , 0.51–0.76 and hazard ratio , 0.64 ; 95 % confidence interval , 0.46–0.91 , respectively ; pairwise interaction P value , 0.88 ) ; risk was not significantly reduced for the intensive group in the smaller alone-for-rest and the alone-for-BP-measurement categories . Similar BP levels and cardiovascular disease risk reduction were observed in the intensive group in SPRINT participants whether the measurement technique used was primarily attended or unattended . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01206062 Objective Blood pressure measurements taken by patients at home ( HBP )  are usually referred to as ‘ self ’ or ‘ home ’ measurements . To demonstrate the most appropriate term we compared self-home measurements ( S-HBP ) , with home measurements taken by relatives ( R-HBP ) , clinic measurements taken by physicians ( P-CBP ) and self- measurements in the clinic ( S-CBP ) . Patients and methods Thirty treated hypertensives were r and omized to an initial clinic BP ( CBP ) monitoring period ( week 1 , P-CBP followed by S-CBP measurements , or the opposite ; 1 visit each ) , then to a HBP monitoring period ( weeks 2–3 , S-HBP followed by R-HBP or the opposite ; 3 workdays each ) , and finally to a second CBP monitoring period ( week 4 , S-CBP followed by P-CBP , or the opposite ) . Triplicate morning trough measurements were taken per occasion using the same fully automated device . Results There was no difference between S-CBP and P-CBP  ( mean difference −1.9 ± 6.1 mmHg , 95 % confidence interval ( CI ) −4.2 , 0.4/−1.6 ± 4.7 , 95 % CI −3.3 , 0.2 , systolic/diastolic ) , or between S-HBP and R-HBP ( −0.9 ± 6.9 , 95 % CI −3.5 , 1.8/−0.4 ± 4.3 , 95 % CI −2.0 , 1.2 ) . S-CBP  was higher than S-HBP ( mean difference 9.3 ± 9.0/4.9 ± 5.4 mmHg , systolic/diastolic , P < 0.001 ) and R-HBP ( 8.4 ± 9.1/4.5 ± 5.0 , P < 0.001 ) . P-CBP  was also higher than S-HBP ( 11.2 ± 11.9/6.5 ± 6.8 , P < 0.001 ) and R-HBP ( 10.3 ± 11.2/6.1 ± 6.5 , P < 0.001 ) . Conclusions Self- measurements provide similar BP levels to measurements taken by relatives or physicians , provided that measurements are taken in the same setting . ‘ Self-BP ’ is a misnomer because self-measurement has no impact on the difference between home and clinic BP . Given that this difference can be exclusively attributed to the effect of the different setting , the term ‘ home BP ’ represents a more appropriate term BACKGROUND Automated office blood pressure ( AOBP ) measuring devices are increasingly recommended as preferred blood pressure ( BP ) diagnostic tools , but it is unclear how they compare and how clinical environments impact their performance . METHODS This prospect i ve r and omized factorial parallel 4-group study compared BP estimates by BpTRU ( VSM MedTech , Vancouver , BC , Canada ) and Omron HEM 907 ( Omron Healthcare , Kyoto , Japan ) devices in closed vs open areas . Patients diagnosed with hypertension were recruited during office visits . After baseline open-room AOBP measurement with the BpTRU , patients had a second  BP measurement  with either the BpTRU or HEM 907 in either open or closed areas . Absolute BP levels and differences between the first and second measurements were compared . Diagnostic performance was also assessed . RESULTS Two hundred fifty-eight patients were studied . Their mean age was 66.2 ± 12.0 years , and 62 % were men . The mean of first AOBP estimates was 127.4/73.3 mm Hg . Analyses of subsequent measurements revealed no influence of open or closed areas on BP means and diagnostic performance . Conversely , the Omron HEM 907 exceeded BpTRU systolic BP measurements by 4.6 mm Hg ( < 0.01 ) in closed areas and by 3.9 mm Hg ( < 0.01 ) in open areas . The discrepancy between devices was amplified at lower BP levels . CONCLUSIONS Although different areas did not influence BP estimates , the Omron HEM 907 significantly exceeded BpTRU measurements on average and especially at lower BP levels . These differences should be considered when interchanging devices and could have clinical decision impacts in a population of patients treated for hypertension . Our results support the constant use of only 1 device type in a given clinic Refractory hypertension is a recently described phenotype of antihypertensive treatment failure defined as uncontrolled blood pressure ( BP ) despite the use of ≥5 different antihypertensive agents , including chlorthalidone and spironolactone . Recent studies indicate that refractory hypertension is uncommon , with a prevalence of ≈5 % to 10 % of patients referred to a hypertension specialty clinic for uncontrolled hypertension . The prevalence of white-coat effect , that is , uncontrolled automated office BP ≥135/85 mm Hg and controlled out-of-office BP < 135/85 mm Hg , by awake ambulatory BP monitor in hypertensive patients overall is ≈30 % to 40 % . The prevalence of white-coat effect among patients with refractory hypertension has not been previously reported . In this prospect i ve evaluation , consecutive patients referred to the University of Alabama at Birmingham Hypertension Clinic for uncontrolled hypertension were enrolled . Refractory hypertension was defined as uncontrolled automated office BP ≥135/85 mm Hg with the use of ≥5 antihypertensive agents , including chlorthalidone and spironolactone  . Automated office BP measurements were based on 6 serial readings , done automatically with the use of a BpTRU device unobserved in the clinic . Out-of-office BP measurements were done by 24-hour ambulatory BP monitor . Thirty-four patients were diagnosed with refractory hypertension , of whom 31 had adequate ambulatory BP monitor readings . White-coat effect was present in only 2 patients , or 6.5 % of the 31 patients with refractory hypertension , suggesting that white-coat effect is largely absent in patients with refractory hypertension . These findings suggest that white-coat effect is not a common cause of apparent lack of BP control in patients failing maximal antihypertensive treatment 
    Output:
    
However , the available evidence suggests that attended AOBP yielded higher systolic and diastolic BP levels and it seems that the procedural methodology determines partially the statistical heterogeneity across studies