***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 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 Abstract . Objectives : To compare compliance with an antihypertensive treatment administered either twice daily or three times daily . The two formulations of the antihypertensive treatment used ( nicardipine ) “ regular tablets ” ( t.d . ) and “ slow release tablets ” ( b.d . ) are bioequivalent at the daily dosage used in the study . Study design : Open , controlled , parallel design ed study with central ised , r and omised allocation to the treatment groups : TID group : A nicardipine 20 mg tablet , three times daily for 3 months . BID group : A capsule of slow release ( SR ) nicardipine , 50 mg twice daily for 3 months . Patients : 7274 hypertensive patients were investigated by 2.651 general practitioners .  Compliance with the nicardipine was assessed by means of st and ardised interviews with the patients and by a question naire for the investigators . Results : Compliance was slightly higher in the BID than in the TID group ; 71.2 % and 24.5 % of patients in the first group declared their compliance was 100 % and 80 % compared to 82.3 % and 15 % in the second group . A statistically significant relationship was shown between compliance with nicardipine  and the decrease in blood pressure after three months of therapy . However , no significant difference was noticed between the two groups of patients in the absolute decrease in blood pressure after the treatment period : 25.7/14.7 mm Hg in the TID group compared with 25.9/15.0 mm Hg in the BID group . Conclusions : A difference in compliance between the bioequivalent BID and TID formulations of the same active agent was shown in hypertensive patients . However , the difference was not large enough to lead to a difference either in the number of controlled patients or in the decrease in blood pressure . Reducing the number of daily doses does not automatically lead to greater efficacy of treatment Predictors of dropping out of care were examined for 171 treated hypertensive patients enrolled in a r and omized trial of social support strategies design ed to improve  compliance and blood pressure control . Control patients who continued to receive routine care  were more than twice as likely to drop out as patients who received routine care and periodic home visits by nurses or pharmacists ( odds ratio [OR]= 2.7 ) . The combination of home visits and a second intervention , having family members monitor patients ' blood pressure and compliance behavior , was no more effective than home visits alone ( OR = 1.1 ) . The home visits intervention was one of six variables identified by a stepwise regression as significant predictors of dropping out . Patients with four or more high-risk characteristics constituted 15 % of the sample but contributed almost half ( 46 % ) of the dropouts . Targeting support strategies at high-risk patients may be a cost-effective means of reducing uncontrolled hypertension Address correspondence to : L.D. Saunders , Department of Health Services Administration and Community Medicine , 13 - 103 Clinical Sciences Building , University of Alberta , Edmonton , Alberta Canada T6 G 2G3 among patients attending a primary health care ( PHC ) clinic in Soweto for antihypertensive drug therapy .  In a 1-year follow-up study of an inception cohort of newly treated hypertensives , only 27 % were compliant ( defined as attending frequently enough to receive 80 % or more of their required treatment ) , 42 % were not seen after the first 3 months ( early dropouts ) , and 22 % continued to attend until the last 3 The effects of metoprolol ( Betaloc tablets ) in a group of 193 hypertensives were compared with the effects of a slow-release formulation ( Betaloc Durules ) in a further group of 196 patients . Patients were selected at r and om for treatment . There were no differences between the groups in terms of age , weight , sex , blood pressure , concurrent illness or concomitant therapy . Blood pressure control and apparent adverse effects were similar for both groups ; the overall withdrawal rate from each group was similar . Compliance , assessed by tablet counts , was significantly improved in the group receiving once-daily therapy . Simplification of the dosage regimen to once-daily therapy appears to improve the patient 's willingness to comply with the physician 's instructions A multifactorial health-education program design ed to enhance compliance with a once-daily regimen of atenolol was evaluated among 453 patients enrolled in health maintenance organizations ( HMOs ) . The initiation of the 180-day study period was used to classify patients as either new or existing cases of hypertension . In turn , patients in these two categories were r and omly assigned to a control or an experimental group . Patients assigned to the experimental groups received an enrollment kit upon exercising their initial prescription ( new patients ) or their first refill request ( existing patients ) . The kit contained : a 30-day supply of atenolol ; an educational newsletter about hypertension ; information on nutrition and life-style changes ; and an explanation of the intent and content of the program . Before the next scheduled prescription-refill date , each patient was contacted by telephone to inquire about his or her experience with the therapy and to stress the importance of adherence to the regimen . Each month thereafter , the newsletter and an enclosed prescription-refill reminder were mailed to each patient . The medication possession ratio , defined as the number of days ' supply of atenolol  obtained by a patient during the 180-day study period , was significantly ( P less than or equal to 0.001 ) enhanced for the new and existing experimental groups relative to the control groups . Multiple regression analyses revealed that enrollment in the health-education program increased the number of days ' supply of atenolol obtained by existing patients by 27 ( P less than or equal to 0.001 ) , and by new patients by 40 ( P less than or equal to 0.001 ) Low rates of adherence to hypertensive therapy  limit patients ' securing the full benefits of treatment . While some factors related to adherence have been identified , research on the effectiveness of interventions to increase adherence levels is sparse . The present study was design ed to assess the impact of a series of different interventions on a group of some 400 patients , all under the care of private physicians in a small community . A factorial design was employed to deliver four , sequential educational interventions , about four months apart , to r and omly selected sub-groups . Interviews before and after each intervention provided information concerning self-reported adherence , health status , health beliefs , and personal characteristics . Pertinent medical records and pharmacy data were also obtained . The first intervention — printed material —did not significantly affect adherence . The second and fourth interventions —nurse telephone calls and social support — each increased medication taking and the third intervention — self-monitoring — led to better weight control . There was no cumulative impact of the interventions and different aspects of regimens were not signiticantly related to one another In this r and omized controlled trial , the value of using occupational health nurses ( OHNs ) to monitor the care of hypertensive employees at work was compared with regular care ( RC ) delivered in the community . One year after entry , the blood pressure level , medication history , compliance with treatment , and cost of hypertensive care of the participants were determined by independent evaluators . The reduction in diastolic blood pressure ( DBP ) , the measure of effectiveness , was 10.5 + /- 1.1 mm Hg ( mean + /- SEM ) in the OHN group and 7.7 + /- 1.1 mm Hg in the RC group , and the proportion under good blood pressure control was 41.8 % and 31.0 % respectively . These between-group differences were not statistically significant . Although the employees in the OHN group were more medicated and had a lower treatment dropout rate , neither difference was statistically significant . In addition , the proportion of employees who were compliant with prescribed medication was virtually identical in both groups . The cost of the care received by employees in the OHN group of $ 404.14 for the year was substantially higher than that of $ 250.15 in the RC group with the difference principally related to the cost of visiting the OHNs and a significant difference in drug cost ( p less than 0.006 ) . The incremental cost-effectiveness ( C/E ) ratio of $ 53.67 per mm Hg DBP reduction per year for onsite blood pressure monitoring was higher than the base C/E ratio of $ 32.65 per mm Hg for regular care . Our findings indicate that monitoring the blood pressure of hypertensive employees at work is neither clinical ly effective nor cost-effective . ( ABSTRACT TRUNCATED AT 250 WORDS A 1-year , r and omized study was conducted to test the possibility of improving compliance with  therapeutic regimens  in hypertensives by means of certain simple arrangements . Patients were given written treatment instructions concerning hypertension , a personal blood-pressure follow-up card , and , for those who failed to attend their blood-pressure check-up , an invitation for a new check-up . Using matched pairs , 202 Finnish hypertensives were r and omly allocated either to an ordinary or a reorganized treatment group . By means of the latter system , patient compliance could be significantly ( p < 0.01 ) improved : Only 4 % of the patients in this group dropped out of treatment , compared with 19 % in the ordinary treatment group . By the end of the year , blood pressure had been lowered by at least 10 % in 95 % of the patients in the reorganized group and in 78 % of those in the ordinary group ( p < 0.01 ) . This was achieved in approximately 60 % of cases using chlorthalidone alone Poor compliance is a principal cause of treatment failure in hypertensive patients . Once-daily dosing improves compliance , but 24-h antihypertensive activity should be provided . The compliance , efficacy , and safety of amlodipine and nifedipine slow-release ( SR ) were compared in patients with mild-to-moderate essential hypertension recruited among 24 centers in France . After a 2-week washout period , 103 patients were r and omized to 12 weeks of 5 to 10 amlodipine mg once daily ( n = 55 ) or 20 mg nifedipine SR twice daily ( n = 48 ) . Compliance was calculated by electronic drug monitoring . Efficacy was measured by ambulatory and casual BP recordings . Patients receiving amlodipine demonstrated better compliance than patients receiving nifedipine SR with respect to compliance index ( the total number of doses taken divided by the total number of doses prescribed , expressed as a percentage ; 98.3 % v 87 % ; P < .0001 ) , days on which the correct number of doses were taken ( 92.5 % v 74.8 % ; P < .0001 ) , and prescribed doses taken on schedule ( 88.7 % v 71.6 % ; P < .0001 ) . Absolute and relative therapeutic coverage were higher in patients receiving amlodipine than nifedipine SR ( P < .0001 ) . Mean SBP and DBP decreased equally in both groups , although amlodipine offered better BP control compared with nifedipine SR at specific times of day . Fewer patients had high nocturnal SBP with amlodipine ( 39.3 % ) than nifedipine SR ( 71.4 % ; P = .042 ) . Adverse events and treatment withdrawals occurred less frequently in amlodipine-treated patients than in nifedipine SR-treated patients . Amlodipine ( 5 to 10 mg ) once daily provides improved compliance , better 24-h BP control , and fewer adverse events than 20 mg nifedipine SR twice daily in patients with mild-to-moderate hypertension A controlled , r and omized study was conducted in two chain pharmacies to determine the clinical value of comprehensive pharmacy services for hypertensive patients in a chain pharmacy setting . Twenty-seven patients were enrolled as intervention participants with 26 control subjects . Monthly services for the intervention group included blood pressure and heart rate assessment s and counseling on lifestyle modifications and drug therapy . Control patients received initial and final blood pressure measurements and minimal counseling . Both study and control groups completed quality -of-life question naires upon entering and completing the study . Results showed that blood pressure control was significantly improved in the study group . Compliance rates as well as energy/fatigue scores ( a quality -of-life scale ) improved in the study group compared with the control population . Community pharmacists in chain stores could have a beneficial effect on the health care of large numbers of patients if pharmaceutical care programs were developed This article reports a r and omized controlled trial design ed to test the effects of special packaging of antihypertensive medication on compliance and blood pressure control . One hundred eighty subjects who had exhibited elevated blood pressure greater than 90 mmHg in the two years prior to the study were recruited from patients receiving care at a community hospital-based family medicine practice 
    Output:
    
REVIEW ERS ' CONCLUSIONS Reducing the number of daily doses appears to be effective in increasing adherence to blood pressure lowering medication and should be tried as a first line strategy , although there is less evidence of an effect on blood pressure reduction .