***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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    ***EXAMPLES*** 
    Input: This study investigated the differences in the effect of an angiotensin converting enzyme inhibitor ( ACEI ) compared with an angiotensin receptor blocker ( ARB ) on blood pressure ( BP ) and pulse pressure ( PP ) measured in the clinic ( CBP and CPP , respectively ) , at home ( HBP , HPP ) and with ambulatory monitoring ( ABP , APP ) . Twenty-seven hypertensive patients were r and omised to receive lisinopril ( 20 mg ) or losartan ( 50 mg ) for 5 weeks , and were subsequently crossed-over to the alternative treatment for a second 5-week period . Measurements of CBP , 24-h ABP and 5-days HBP were performed before r and omisation and at the end of each treatment period . All measurement methods showed that lisinopril was more effective than losartan in reducing BP . However , the difference between the two drugs was demonstrated with greater precision using HBP ( P<0.001 ) than 24-h ABP ( P<0.01 ) , whereas the poorest precision for demonstrating this difference was provided by CBP ( P<0.05 ) . Lisinopril was also found more effective than losartan in reducing HPP ( P=0.01 ) and 24-h APP ( P=0.03 ) whereas no such a difference was detected using measurements of CPP . It was concluded that the antihypertensive drugs may differ in their effects not only on BP , but also on PP . HBP monitoring appears to be as reliable as 24-h ABP monitoring in detecting differences in the effect of drugs on both BP and PP . Clinic measurements seem to be the least reliable method , particularly in the detection of differences in PP Objective To compare the predictive powers of self-measurement of blood pressure at home ( home blood pressure measurement ) and casual ( screening ) blood pressure measurement for mortality . Design A prospect i ve cohort study . Subjects and methods We obtained  home and screening blood pressure measurements for 1789 subjects aged ≥ 40 years who were followed up for a mean of 6.6 years . The prognostic significance of blood pressure for mortality was determined by the Cox proportional hazards regression model adjusted for age , sex , smoking status , past history of cardiovascular disease , and the use of antihypertensive medication . Results When the home blood pressure values and the screening blood pressure values were simultaneously incorporated into the Cox model as continuous variables , only the average of multiple ( taken more than three times ) home systolic blood pressure values was significantly and strongly related to the cardiovascular mortality risk . The average of the two initial home blood pressure values was also better related to the mortality risk than were the screening blood pressure values . Conclusions Home blood pressure measurement had a stronger predictive power for mortality than did screening blood pressure measurement for a general population . This appears to be the first study in which the prognostic significance s of home and screening blood pressure measurements have been compared It is still uncertain whether one can safely base treatment decisions on self-measurement of blood pressure . In the present study , we investigated whether antihypertensive treatment based on self-measurement of blood pressure leads to the use of less medication without the loss of blood pressure control . We r and omly assigned 430 hypertensive patients to receive treatment either on the basis of self-measured pressures ( n=216 ) or office pressures ( OPs ; n=214 ) . During 1-year follow-up , blood pressure was measured by office measurement ( 10 visits ) , ambulatory monitoring ( start and end ) , and self-measurement ( 8 times , self-pressure group only ) . In addition , drug use , associated costs , and degree of target organ damage ( echocardiography and microalbuminuria ) were assessed . The self-pressure group used less medication than the OP group ( 1.47 versus 2.48 drug steps ; P<0.001 ) with lower costs ( $ 3222 versus $ 4420 per 100 patients per month ; P<0.001 ) but without significant differences in systolic and diastolic OP values ( 1.6/1.0 mm Hg ; P=0.25/0.20 ) , in changes in left ventricular mass index ( -6.5 g/m(2 ) versus -5.6 g/m(2 ) ; P=0.72 ) , or in median urinary microalbumin concentration ( -1.7 versus -1.5 mg per 24 hours ; P=0.87 ) . Nevertheless , 24-hour ambulatory blood pressure values at the end of the trial were higher in the self-pressure than in the OP group : 125.9 versus 123.8 mm Hg ( P<0.05 ) for systolic and 77.2 versus 76.1 mm Hg ( P<0.05 ) for diastolic blood pressure . These data show that self-measurement leads to less medication use than office blood pressure measurement without leading to significant differences in OP values or target organ damage . Ambulatory values , however , remain slightly elevated for the self-pressure group We examined the effects of the addition of low-dose indapamide to antihypertensive drugs of other classes , as well as its duration of action , using blood pressure ( BP ) self-monitoring at home . Seventy-six patients undergoing monotherapy with a calcium channel blocker ( CCB ) , angiotensin converting-enzyme inhibitor ( ACEI ) , or angiotensin AT1-receptor blocker ( ARB ) , but had an average morning home systolic BP ( SBP ) ≥ 135 mmHg or diastolic BP ( DBP ) ≥ 85 mmHg , were studied .  Indapamide ( 1 mg ) was added to their existing treatment once daily for 4 weeks . The additional hypotensive effects  of indapamide were evaluated by casual and home BPs , and the results were compared among the three groups of subjects classified according to their initial drug treatment classes . The morning/evening ( M/E ) ratio of BP reduction was calculated to assess the duration of the effect . Overall , indapamide significantly ( P < 0.001 ) lowered morning home BP ( 147 ± 12/87 ± 9 mmHg to 135 ± 12/81 ± 9 mmHg ) , evening home BP ( 138 ± 15/79 ± 10 mmHg to 126 ± 12/73 ± 9 mmHg ) , and casual BP ( 145 ± 21/86 ± 14 mmHg to 136 ± 17/81 ± 13 mmHg ) . All groupsshowed significant indapamide-induced home SBP/DBP decreases , whereas only the ACEI and ARB groups , but not the CCB group , showed a home pulse pressure ( PP ) reduction . Evening SBP and PP decreases were significantly greater in the ARB group than in the CCB group . The mean M/E ratio with indapamide was 0.95 for SBP and 0.85 for DBP . Low-dose indapamide used in combination can provide additional anti-hypertensive efficacy lasting for 24 h. The added effect of indapamide may be more prominent on ARBs than on CCBs Background The goal of the present study was to assess the effect of antihypertensive therapy on clinic ( CBP ) and ambulatory ( ABP ) blood pressures , on ECG voltages , and on the incidence of stroke and cardiovascular events in older patients with sustained and nonsustained systolic hypertension . Methods and Results Patients who were ≥60 years old , with systolic CBP of 160 to 219 mm Hg and diastolic CBP of < 95 mm Hg , were r and omized into the double-blind placebo-controlled Systolic Hypertension in Europe ( Syst-Eur ) Trial . Treatment consisted of nitrendipine , with the possible addition of enalapril , hydrochlorothiazide , or both .  Patients enrolled in the Ambulatory Blood Pressure Monitoring Side Project were classified according to daytime systolic ABP into 1 of 3 subgroups : nonsustained hypertension ( < 140 mm Hg ) , mild sustained hypertension ( 140 to 159 mm Hg ) , and moderate sustained hypertension ( ≥160 mm Hg ) . At baseline , patients with nonsustained hypertension had smaller ECG voltages ( P < 0.001 ) and , during follow-up , a lower incidence of stroke ( P < 0.05 ) and of cardiovascular complications ( P = 0.01 ) than other groups . Active treatment reduced ABP and CBP in patients with sustained hypertension but only CBP in patients with nonsustained hypertension ( P < 0.001 ) . The influence of active treatment on ECG voltages ( P < 0.05 ) and on the incidence of stroke ( P < 0.05 ) and cardiovascular events ( P = 0.06 ) was more favorable than that of placebo only in patients with moderate sustained hypertension . Conclusions Patients with sustained hypertension had higher ECG voltages and rates of cardiovascular complications than did patients with nonsustained hypertension . The favorable effects of active treatment on these outcomes were only statistically significant in patients with moderate sustained hypertension 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 systolic/diastolic differences between the home and office BP groups averaged 6.8/3.5 mm Hg , 4.9/2.9 mm Hg , and 4.9/2.9 mm Hg , respectively . Left ventricular mass and reported symptoms were similar in the 2 groups . Costs per 100 patients followed up for 1 month were only slightly lower in the home BP group ( 3875 vs 3522 [ 4921 dollars vs 4473 dollars ] ; P = .04 ) . CONCLUSIONS Adjustment of antihypertensive treatment based on home BP instead of office BP led to less intensive drug treatment and marginally lower costs but also to less BP control , with no differences in general well-being or left ventricular mass . Self-measurement allowed identification of patients with white-coat hypertension . Our findings support a stepwise strategy for the evaluation of BP in which self-measurement and ambulatory monitoring are complementary to conventional office measurement and highlight the need for prospect i ve outcome studies to establish the normal range of home-measured BP The purpose of this study was to compare several diltiazem-based antihypertensive drug combinations and assess the usefulness of home blood pressure monitoring in the evaluation of the efficacy of combination pharmacotherapy . Sixteen general practitioners recruited hypertensive subjects uncontrolled on diltiazem monotherapy , who were r and omized to receive eight weeks of add-on therapy with a diuretic ( chlorthalidone ) , a dihydropyridine calcium antagonist ( felodipine ) , an ACE inhibitor ( lisinopril ) , or an angiotensin blocker ( valsartan ) .  Sitting office and home blood pressure was measured using electronic devices A&D 767 . A total of 211 patients were r and omized , and 185 completed the study . Of 52 subjects r and omized to felodipine  , 15 were withdrawn due to ankle edema . The additional antihypertensive effect of the second drug was smaller in 18 subjects with a white coat effect ( p < 0.01 ) . All combinations produced a significant decline in office ( 21.2 ± 14.8 / 7.7 ± 9.7 mmHg ) and home ( 17.1 ± 1 
    Output:
    
In conclusion , HBP falls approximately 20 % less than CBP with antihypertensive treatments .