***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: To address the epidemic of hypertension in blacks born and living in sub-Saharan Africa , we compared in a r and omised clinical trial ( NCT01030458 ) single-pill combinations of old and new antihypertensive drugs in patients ( 30–69 years ) with uncomplicated hypertension ( 140–179/90–109 mm Hg ) . After ⩾4 weeks off treatment , 183 of 294 screened patients were assigned to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg ( n=89 ; R ) or amlodipine/valsartan 5/160 mg ( n=94 ; E ) and followed up for 6 months . To control blood pressure ( < 140/<90 mm Hg ) , bisoprolol and amlodipine could be doubled ( 10 mg per day ) and α-methyldopa ( 0.5–2 g per day ) added . Sitting blood pressure fell by 19.5/12.0 mm Hg in R patients and by 24.8/13.2 mm Hg in E patients and heart rate decreased by 9.7 beats per minute in R patients with no change in E patients ( –0.2 beats per minute ) . The between-group differences ( R minus E ) were 5.2 mm Hg ( P<0.0001 ) systolic , 1.3 mm Hg ( P=0.12 ) diastolic , and 9.6 beats per minute ( P<0.0001 ) . In 57 R and 67 E patients with data available at all visits , these estimates were 5.5 mm Hg ( P<0.0001 ) systolic , 1.8 mm Hg ( P=0.07 ) diastolic and 9.8 beats per minute ( P<0.0001 ) . In R compared with E patients , 45 vs 37 % ( P=0.13 ) proceeded to the higher dose of r and omised treatment and 33 vs 9 % ( P<0.0001 ) had α-methyldopa added . There were no between-group differences in symptoms except for ankle oedema in E patients ( P=0.012 ) . In conclusion , new compared with old drugs lowered systolic blood pressure more and therefore controlled hypertension better in native African black patients Background The efficacy of angiotensin-converting enzyme ( ACE ) inhibitors in decreasing blood pressure  in African patients is controversial . Objective We examined the ambulatory blood pressure ( ABP ) response to a diuretic and an ACE inhibitor in hypertensive patients of East African descent and evaluated the individual characteristics that determined treatment efficacy . Design A single-blind r and omized AB/BA crossover design . Setting Hypertensive families of East African descent from the general population in the Seychelles . Participants Fifty-two ( 29 men and 23 women ) out of 62 eligible hypertensive patients were included . Main outcome measures ABP response to 20 mg lisinopril ( LIS ) daily and 25 mg hydrochlorothiazide ( HCT ) daily given for a 4-week period . Results The daytime systolic/diastolic ABP response to HCT was 4.9 [ 95 % confidence interval ( CI ) 1.2–8.6]/3.6 ( 1.0–6.2 ) mmHg for men and 12.9 (9.2–16.6)/6.3 ( 3.7–8.8 ) mmHg for women . With LIS the response was 18.8 (15.0–22.5)/14.6 ( 12.0–17.1 ) mmHg for men and 12.4 (8.7–16.2)/7.7 ( 5.1–10.2 ) mmHg for women . The night-time systolic/diastolic response to HCT was 5.0 (0.6–9.4)/2.7 [ (−0.4)–5.7 ] mmHg for men and 11.5 (7.1–16.0)/5.7 ( 2.6–8.8 ) mmHg for women , and to LIS was 18.7 (14.2–22.1)/15.4 ( 12.4–18.5 ) mmHg for men and 3.5 [(−1.0)–7.9]/2.3 [ (−0.8)–5.4 ] mmHg for women . Linear regression analyses showed that gender is an independent predictor of the ABP responses to HCT and to LIS . Conclusions Hypertensive patients of African descent responded better to  LIS  than to HCT .  Men responded better to LIS than to HCT and women responded similarly to both drugs Objective : To investigate HIV , its treatment , and hypertension as stroke risk factors in Malawian adults . Methods : We performed a case-control study of 222 adults with acute stroke , confirmed by MRI in 86 % , and 503 population controls , frequency-matched for age , sex , and place of residence , using Global Positioning System for r and om selection . Multivariate logistic regression models were used for case-control comparisons . Results : HIV infection ( population attributable fraction [ PAF ] 15 % ) and hypertension ( PAF 46 % ) were strongly linked to stroke . HIV was the predominant risk factor for young stroke ( ≤45 years ) , with a prevalence of 67 % and an adjusted odds ratio ( aOR ) ( 95 % confidence interval ) of 5.57 ( 2.43–12.8 ) ( PAF 42 % ) . There was an increased risk of a stroke in patients with untreated HIV infection ( aOR 4.48 [ 2.44–8.24 ] , p < 0.001 ) , but the highest risk was in the first 6 months after starting antiretroviral therapy ( ART ) ( aOR 15.6 [ 4.21–46.6 ] , p < 0.001 ) ; this group had a lower median CD4 + T-lymphocyte count ( 92 vs 375 cells/mm3 , p = 0.004 ) . In older participants ( HIV prevalence 17 % ) , HIV was associated with stroke , but with a lower PAF than hypertension ( 5 % vs 68 % ) . There was no interaction between HIV and hypertension on stroke risk . Conclusions : In a population with high HIV prevalence , where stroke incidence is increasing , we have shown that HIV is an important risk factor . Early ART use in immunosuppressed patients poses an additional and potentially treatable stroke risk . Immune reconstitution inflammatory syndrome may be contributing to the disease mechanisms The efficacy and safety of the novel calcium antagonist Amlodipine ( Pfizer Laboratories , New York , New York ) and hydrochlorothiazide were evaluated and compared in a r and omized , single-blind , parallel group study in black Africans with essential hypertension . Twenty Nigerians with newly diagnosed mild to moderate essential hypertension were r and omized to receive ascending doses of Amlodipine ( 5 mg and 10 mg ) or hydrochlorothiazide ( 25 mg or 50 mg ) , and blood pressure and heart rate were measured at baseline and at 2 , 4 , and 6 weeks of therapy . Both Amlodipine and hydrochlorothiazide significantly reduced supine and erect blood pressure . Supine blood pressure on Amlodipine fell from a mean of 190/104 mm Hg to 150/79 mm Hg , and on thiazide from 180/103 mm Hg to 141/84 mm Hg . There was , however , no significant difference between both drugs in antihypertensive efficacy . Neither drug induced a reflex increase in heart rate . The fall in blood pressure on both agents was associated with an increase in plasma urea .  Amlodipine induced no change in plasma potassium , but hydrochlorothiazide caused hypokalemia . Both agents were well tolerated , and Amlodipine should undergo further study in the treatment of hypertension in blacks BACKGROUND In the treatment of hypertension in subjects of African origins , although hydrochlorothiazide ( HCTZ ) is not as effective as calcium channel blockers , indapamide is superior to HCTZ . In the present study we therefore compared the effects of slow release ( SR ) indapamide with the calcium channel blocker amlodipine , when used as initial therapy , on blood pressure ( BP ) and left ventricular mass ( LVM ) during 6 months of treatment in this group . METHODS Patients with a mean daytime ambulatory diastolic BP > or = 90 mm Hg and < or = 110 mm Hg ( n = 125 , aged 53 + /- 11 years , 68 % women ) were r and omized to receive open-label 1.5 mg of indapamide SR or 5 mg of amlodipine . If daytime ambulatory diastolic BP at 1 month was > /=90 mm Hg , 4 mg of perindopril was added to indapamide SR or the dose of amlodipine was increased to 10 mg . RESULTS After 1 month of therapy , there was an equivalent decline in systolic and diastolic BP in both groups ( P < .0001 ) . In the indapamide-treated group ( n = 62 ) the daytime BP decreased from 153 + /- 12/101 + /- 6 mm Hg to 138 + /- 15/92 + /- 10 mm Hg and for amlodipine ( n = 58 ) , it decreased from 152 + /- 13/99 + /- 5 mm Hg to 138 + /- 12/91 + /- 8 mm Hg . At 6 months daytime ambulatory BP decreased to 130 + /- 15/86 + /- 8 mm Hg and to 129 + /- 11/85 + /- 5 mm Hg for the indapamide SR ( n = 42 ) and amlodipine ( n = 44 ) treatment groups , respectively . Both groups showed equivalent regression of LVM index and relative wall thickness . CONCLUSIONS These data suggest that in hypertensive patients of African ancestry initiating therapy with 1.5 mg of indapamide SR and then adding 4 mg of perindopril is equally as effective as amlodipine therapy at reducing BP , and modifying target organ damage The antihypertensive effects of penbutolol , a nonselective beta-adrenoceptor antagonist with intrinsic sympathomimetic activity , was assessed in nonobese black South Africans aged 25 to 65 years with uncomplicated mild to moderate essential hypertension . After a 4-week placebo run-in period 50 patients entered a r and omized  placebo-controlled study with a crossover design . For 8 weeks they received a once daily dose of 40 mg penbutolol ( or placebo ) which was increased to 80 mg per day for the next 4 weeks in poor responders . This was followed by a 4-week placebo washout period after which a crossover of treatment was achieved and a second 12-week period of treatment initiated . Thirty-five patients completed the whole study and in 15 patients diastolic blood pressure was reduced below 95 mm Hg . The mean systolic pressures of these patients decreased by 21 mm Hg and their mean diastolic pressure decreased by 11 mm Hg during treatment with penbutolol . These results suggest that penbutolol monotherapy is an alternative therapeutic approach to hypertension in black South Africans BACKGROUND The Pan-African Society of Cardiology ( PASCAR ) has identified hypertension as the highest area of priority action to reduce heart disease and stroke on the continent . OBJECTIVES The aim of this PASCAR roadmap on hypertension was to develop practical guidance on how to implement strategies that translate existing knowledge into effective action and improve detection , treatment and control of hypertension and cardiovascular health in sub-Saharan Africa ( SSA ) by the year 2025 . METHODS Development of this roadmap started with the creation of a consortium of experts with leadership skills in hypertension . In 2014 , experts in different fields , including physicians and nonphysicians , were invited to join . Via face-to-face meetings and teleconferences , the consortium made a situation analysis , set a goal , identified roadblocks and solutions to the management of hypertension and customized the World Heart Federation roadmap to Africa . RESULTS Hypertension is a major crisis on the continent but very few r and omized controlled trials have been conducted on its management . Also , only 25.8 % of the countries have developed or adopted guidelines for management of hypertension . Other major roadblocks are either government and health-system related or health care professional or patient related . The PASCAR hypertension task force identified a 10-point action plan to be implemented by African ministries of health to achieve 25 % control of hypertension in Africa by 2025 . CONCLUSIONS Hypertension affects millions of people in SSA and if left untreated , is a major cause of heart disease and stroke . Very few SSA countries have a clear hypertension policy . This PASCAR roadmap identifies practical and effective solutions that would improve detection , treatment and control of hypertension on the continent and could be implemented as is or adapted to specific national setting Summary The antihypertensive efficacy both of angiotensin converting enzyme ( ACE ) inhibitors and thiazide diuretics has been cl aim ed to be influenced by plasma renin activity , which declines 
    Output:
    
Fewer studies assessing combination therapy were available , but there was a trend towards superiority for CCBs plus ACE inhibitors or diuretics compared to other combinations .
Evidence broadly supports current guidelines and provides a clear rationale for promoting CCBs as first-line agents and early initiation of combination therapy .