***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: One hundred forty-nine patients between 56 and 80 years of age with mild to moderate hypertension received indapamide ( 2.5 mg per day ) monotherapy for 12 weeks . In addition to studies of the efficacy and tolerance of indapamide , the study comprised an assessment of well-being , which was carried out objective ly by the physician , and subjectively by the patient himself , by means of a list of complaints and a visual analogue scale . The mean blood pressure was lowered from 179/91 mm Hg ( supine ) before treatment to 149/81 mm Hg at the end of the treatment . The general well-being of the patients , as judged by the physician , showed a markedly positive evolution . The patients themselves indicated that their most frequent symptoms , such as sleep disorders , functional organic disturbances , and sensory and motor fatigue , had improved by 65 to 85 percent , indicating a tendency to better compliance AIM To investigate the effect of substituting beta-blockers with nebivolol on the  erectile function of patients suffering from essential hypertension . METHODS Forty-four young and middle-aged men ( 31 - 65 years ) with essential hypertension visited our outpatient clinic and took beta-blocker treatment  ( atenolol , metoprolol or bisoprolol )  for more than 6 months . All the patients completed a question naire regarding erectile function ( International Index for Erectile Function ) . Patients were then switched to an equipotent dose of nebivolol for 3 months and , at the end of this time period , filled out the same question naire . RESULTS Twenty-nine out of the 44 ( 65.9 % ) patients who took beta-blockers ( atenolol , metoprolol or bisoprolol ) had exhibited erectile dysfunction ( ED ) . Their systolic and diastolic blood pressure did not change significantly with the treatment switch . In 20 out of these 29 ( 69 % ) patients , a significant improvement in the erectile function score was exhibited after 3 months of nebivolol administration , and in 11 of these 20 patients , erectile function was normalized . CONCLUSION Nebivolol seems to have a beneficial effect on ED ( possibly due to increased nitric oxide availability ) ; however , further prospect i ve , r and omized , placebo-controlled studies are needed to confirm the beneficial effects of nebivolol Erectile dysfunction is one of the major obstacles for noncompliance in the antihypertensive treatment . It has been shown that various antihypertensive drugs have a negative influence on sexual activity such as diuretics and β-blockers . Thus , the purpose of the present study was to evaluate the effect of valsartan , an AT1-receptor antagonist , or its combination with hydrochlorothiazide on sexual activity in hypertensive patients . A total of 2202 patients ( mean age 54±8 years ) with hypertension systolic blood pressure (SBP)⩾140 mmHg , diastolic blood pressure (DBP)⩾95 mmHg ) , or with pretreated hypertension , were included in the present analysis . Blood pressure was measured at baseline , after 8 and 16 weeks , respectively . Sexual activity was assessed with a question naire at each of the three visits . Sexual activity ( intercourse per week ) was determined in three groups : controls ( n=27 ; conventional therapy ) ; valsartan group ( n=1899 ) ; valsartan in combination with hydrochlorothiazide ( n=276 ) . There were 26 drop outs . SBP ( −18.6 mmHg ) and DBP ( −11.6 mmHg ) decreased significantly in all three groups . Sexual activity decreased slightly in controls from 1.3 to 0.9 times per week ( NS ) , whereas it increased in the valsartan group from 1.0 to 1.6 times during follow-up ( P<0.0001 ) . Similarly , sexual activity increased in the combination group from 0.9 to 1.3 times per week during follow-up ( P<0.0001 ) . No sexual activity was reported by 467 ( 21 % ) of the 2202 patients at baseline and 154 ( 7 % ) at 16 weeks follow-up ( P<0.05 ) . Impaired sexual activity is common in hypertensive patients ( app . 20 % ) . Valsartan increases the rate of sexual intercourses per week , whereas conventional therapy affects sexual activity adversely Abstract Objective : To determine whether tight control of blood pressure with either a β blocker or an angiotensin converting enzyme inhibitor has a specific advantage or disadvantage in preventing the macrovascular and microvascular complications of type 2 diabetes . Design : R and omised controlled trial comparing an angiotensin converting enzyme inhibitor ( captopril ) with a β blocker ( atenolol ) in patients with type 2 diabetes aim ing at a blood pressure of < 150/<85 mm Hg . Setting : 20 hospital based clinics in Engl and , Scotl and , and Northern Irel and . Subjects : 1148 hypertensive patients with type 2 diabetes ( mean age 56 years , mean blood pressure 160/94 mm Hg ) . Of the 758 patients allocated to tight control of blood pressure , 400 were allocated to captopril and 358 to atenolol . 390 patients were allocated to less tight control of blood pressure . Main outcome measures : Predefined clinical end points , fatal and non-fatal , related to diabetes , death related to diabetes , and all cause mortality . Surrogate measures of microvascular and macrovascular disease included urinary albumin excretion and retinopathy assessed by retinal photography . Results : Captopril and atenolol were equally effective in reducing blood pressure to a mean of 144/83 mm Hg and 143/81 mm Hg respectively , with a similar proportion of patients ( 27 % and 31 % ) requiring three or more antihypertensive treatments . More patients in the captopril group than the atenolol group took the allocated treatment : at their last clinic visit , 78 % of those allocated captopril and 65 % of those allocated atenolol were taking the drug ( P<0.0001 ) . Captopril and atenolol were equally effective in reducing the risk of macrovascular end points . Similar proportions of patients in the two groups showed deterioration in retinopathy by two grade s after nine years ( 31 % in the captopril group and 37 % in the atenolol group ) and developed clinical grade albuminuria ≥300 mg/l ( 5 % and 9 % ) . The proportion of patients with hypoglycaemic attacks was not different between groups , but mean weight gain in the atenolol group was greater ( 3.4 kg v 1.6 kg ) . Conclusion : Blood pressure lowering with captopril or atenolol was similarly effective in reducing the incidence of diabetic complications . This study provided no evidence that either drug has any specific beneficial or deleterious effect , suggesting that blood pressure reduction in itself may be more important than the treatment used The effects of indapamide and captopril on office and ambulatory blood pressure control and on general well-being were investigated in 30 active , r and omly selected patients from 25 to 68 years old , with mild to moderate essential hypertension ( diastolic blood pressure , 92 to 114 mm Hg ) . Twenty-four-hour ambulatory blood pressure monitoring using an ICR model 5200 portable recorder and evaluation of general well-being were performed prior to and at the end of three months of therapy with indapamide 2.5 mg given once daily , or captopril 12.5 to 50 mg given twice daily . Indapamide and captopril were equally effective in controlling blood pressures in clinic and during 24-hour activities . Although general well-being and subjective symptomatology improved with both treatments , the only significant difference between the two drugs was improvement in the sleep dysfunction scale with indapamide ( p less than 0.02 ) . The results shown in this study suggest that both indapamide ( 2.5 mg ) once daily and captopril ( 12.5 to 50 mg ) twice daily are suitable drugs for initial therapy of active patients with mild to moderate hypertension . A fixed once-daily dosage of an antihypertensive agent may , however , increase patient compliance and convenience OUTCOMES Extensive data from r and omised controlled trials have shown the benefit of treating hypertension . The target blood pressure ( BP ) for antihypertensive management is systolic < 140 mmHg and diastolic < 90 mmHg with minimal or no drug side-effects ; however , stricter BP control is required for patients with end-organ damage , co-existing risk factors and co-morbidity , e.g. diabetes mellitus . The reduction of BP in the elderly and in those with severe hypertension should be achieved gradually over 1 month . Co-existent risk factors should also be controlled . BENEFITS Benefits of management include reduced risks of stroke , cardiac failure , chronic kidney disease and coronary heart disease . RECOMMENDATIONS The correct BP measurement procedure is described , and evaluation of cardiovascular risk factors and recommendations for antihypertensive therapy are stipulated . The total cardiovascular disease risk profile should be determined for all patients to inform management strategies . Lifestyle modification and patient education are cornerstones in the management of every patient . Major indications , pre caution s and contra-indications to each recommended antihypertensive drug are listed . Combination therapy should be considered ab initio if the BP is ≥ 20/10 mmHg . First-line drug therapy for uncomplicated hypertension includes low-dose thiazide-like diuretics , calcium channel blockers ( CCBs ) or angiotensin-converting enzyme inhibitors ( ACE-Is ) ( or ARBs - angiotensin II receptor blockers ) . If the target BP is not obtained , a second antihypertensive should be added from the aforementioned list . If the target BP is still not met , the third remaining antihypertensive agent should be used . In black patients  either thiazide-like diuretics or CCBs can be used initially , because response rates are better than with ACE-Is or β-blockers . In treating resistant hypertension , a central ly acting drug , vasodilator , α-blocker , spironolactone or β-locker should be added . This guideline includes management of specific situations , i.e. hypertensive emergency and urgency , severe hypertension with target organ damage , hypertension in diabetes mellitus , resistant hypertension , fixed drug combinations , new trials in hypertension , and interactions of antihypertensive agents with other drugs . VALIDITY The guideline was developed by the Southern African Hypertension Society 1 Hypertensive men treated with beta‐blockers frequently complain of  erectile dysfunction . The present study investigated the effects of two β1‐adrenoceptor‐selective antagonists , namely nebivolol and metoprolol , on  erectile function in hypertensive men . 2 Male out‐ patients ( age range 40–55 years ) with newly diagnosed or existing stage 1 essential hypertension ( mean seated systolic blood pressure 140–159 mmHg ; diastolic blood pressure 90–99 mmHg ) were enrolled in the study . All patients lived in a stable , heterosexual partnership and had no history of sexual dysfunction . After a 2 eek placebo run‐in period , patients were r and omized double‐blind to either Treatment group A ( comprising nebivolol 5 mg once daily for 12 weeks , followed by placebo for 2 weeks and then metoprolol succinate 95 mg once daily for 12 weeks ) or Treatment group B ( comprising metoprolol succinate 95 mg for 12 weeks , placebo for 2 weeks and then nebivolol 5 mg for 12 weeks ) . An international index of erectile function ( IIEF ) question naire and a diary documented patients ’ sexual function and activity . 3 Nebivolol and metoprolol lowered blood pressure to a similar extent . Metoprolol , but not nebivolol , significantly decreased the IIEF erectile function subscore by 0.92 in the first 8 weeks after onset of beta‐blocker treatment . In contrast with metoprolol , nebivolol improved secondary sexual activity scores and other IIEF subscores . 4 Despite similar antihypertensive efficacy of the cardioselective β1‐adrenoceptor antagonists nebivolol and metoprolol , nebivolol may offer additional benefits by avoiding erectile dysfunction in male hypertensive patients on long‐term β‐adrenoceptor antagonist therapy Background . Studies on the relationship between testosterone concentrations and blood pressure have yielded inconsistent results . Therefore , this study investigated the prospect i ve association of total testosterone ( TT ) concentrations with risk of incident hypertension and blood pressure change in 1484 men aged 20–79 years . Methods . Data from the population -based Study of Health in Pomerania , Germany , were used . Serum TT concentrations , measured by chemiluminescent enzyme immunoassays , were categorised into age-specific quartiles . Generalised Estimating Equation ( GEE ) models , adjusted for age , waist circumference , physical activity , smoking and alcohol consumption were specified . Results . During a median follow-up time of 5.0 years , the prevalence of hypertension increased from 50.6 % to 57.1 % . TT concentrations were significantly lower in men with baseline and incident hypertension . Analyses revealed that men with baseline TT concentrations in the lowest quartile had an increased risk of incident hypertension ( odds ratio ( OR ) , 1.19 
    Output:
    
The revised guidelines never use terms such as loss of libido , ejaculatory dysfunction , lack of orgasm , and priapism .