human
***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 To examine the efficacy of a 3-month clinic-based behavioral nutrition intervention emphasizing a diet high in fruits , vegetables , and low fat dairy ( DASH intervention ) versus routine outpatient hospital-based nutrition care ( RC ) on diet and blood pressure ( BP ) in adolescents with elevated BP . STUDY DESIGN Fifty-seven adolescents with a clinical diagnosis of prehypertension or hypertension ( systolic BP or diastolic BP , 90(th ) to 99(th ) percentile ) were r and omly assigned to  DASH or  RC  .  SBP , DBP , 3-day diet recall , weight , and height were assessed at pretreatment , post-treatment , and 3 months later ( follow-up ) . RESULTS In completer analysis , DASH versus RC had a greater decrease in SBP z scores from baseline to post-treatment ( P < 0.01 ) and a trend for a greater decrease in SBP z scores from baseline through follow-up ( P = .07 ) . DBP z scores changed similarly for conditions from baseline through follow-up . Relative to RC , DASH had a greater increase in intake of fruits ( P < .001 ) , potassium and magnesium ( P < .01 ) , and a greater decrease in total fat ( P < .05 ) from baseline to post-treatment . From baseline through follow-up , DASH versus RC had a greater increase in low fat dairy ( P < .001 ) . CONCLUSIONS The DASH intervention proved more effective than RC in improving SBP and diet quality in adolescents with elevated BP Objective This study compares efficacy and safety of valsartan with enalapril in hypertensive children aged 6–17 years . Method This was a 12-week , r and omized , double-blind , parallel-group , active-controlled study . After a single-blind placebo run-in period ( 4–28 days ) , patients with mean sitting systolic blood pressure ( BP ) ( MSSBP ) at least 95th percentile for age , gender , and height were r and omized to receive half the assigned dose for first week , and force-titrated to full dose for 11 weeks ( ≥18 to < 35 kg – valsartan : 80 mg , enalapril : 10 mg ; ≥35 to < 80 kg – valsartan : 160 mg , enalapril : 20 mg ; ≥80 to ⩽160 kg – valsartan : 320 mg , enalapril : 40 mg ) . The primary efficacy variable was changed from baseline in MSSBP to show noninferiority of valsartan to enalapril . Other efficacy variables were changed from baseline in MSDBP , SBP control rate , and 24-h ambulatory BP parameters . Results Of 300 r and omized patients , 281 ( 94 % ) completed the study . At week 12 , MSSBP reductions were similar for valsartan and enalapril ( primary endpoint of noninferiority , P < 0.0001 ) . Least square mean BP reductions from baseline of −15.4/−9.4 mmHg were observed for valsartan compared with −14.1/−8.5 mmHg for enalapril . A similar proportion of patients achieved SBP control  ( valsartan : 67 % ; enalapril : 70 % ) . In the subset of patients who underwent ambulatory BP assessment s , valsartan provided greater reductions  than enalapril  in mean 24-h SBP  ( valsartan : −9.8 mmHg , enalapril : −7.2 mmHg : P = 0.03 ) . The overall incidence of AEs was similar ( valsartan 60 % , enalapril 58 % ) with headache , cough , and nasopharyngitis reported most frequently . Conclusions Valsartan and enalapril provided comparable BP reductions and effective BP control and were well tolerated in hypertensive children aged 6–17 years BACKGROUND AND OBJECTIVES No large , r and omized , double-blind trials in children with proteinuria treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers have previously been reported . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS This 12-week , double-blind , multinational study investigated the effects of losartan 0.7 to 1.4 mg/kg per day compared with placebo ( normotensive stratum ) or amlodipine 0.1 to 0.2 mg/kg per day up to 5 mg/d ( hypertensive stratum ) on proteinuria ( morning-void urinary protein-creatinine ratio , baseline > or = 0.3 g/g ) in 306 children up to 17 years of age . RESULTS Twelve weeks of treatment with losartan significantly reduced proteinuria compared with amlodipine/placebo : losartan -35.8 % ( 95 % confidence interval : -27.6 % to -43.1 % ) versus amlodipine/placebo 1.4 % ( 95 % confidence interval : -10.3 % to 14.5 % ) , P < or = 0.001 . Significance remained after adjustment for differences across treatment groups in change in BP ( losartan produced incremental systolic and diastolic BP reductions versus amlodipine of 5.4 and 4.6 mmHg , respectively ; and versus placebo of 3.8 and 4.0 mmHg , respectively ) . Proteinuria reduction was consistently observed in the normotensive ( -34.4 % losartan ; 2.6 % placebo ) and hypertensive ( -41.5 % losartan ; 2.4 % amlodipine ) strata , and in all prespecified subgroups , including age , gender , race , Tanner stage , weight , prior therapy with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers , as well as among the most common etiologies of proteinuria . Adverse event incidence was low and comparable in all groups . CONCLUSIONS Losartan significantly lowered proteinuria and was well tolerated after 12 weeks in children aged 1 to 17 years with proteinuria with or without hypertension , a population that has not previously been rigorously studied Background Higher adult blood pressure , even without hypertension , predicts cardiovascular outcomes , and is predicted by childhood blood pressure . Regular dark chocolate intake lowers blood pressure in adults , but effects in children are unknown . Aim To examine the feasibility of school-based provision of dark chocolate and its short-term efficacy in reducing mean group blood pressure . Methods 194 children ( aged 10–12 years ) were r and omised by class to  intervention ( 7 g dark chocolate daily for 7 weeks , n=124 ) or control ( n=70 ) groups ; 98 % and 93 % provided baseline and follow-up measurements , respectively . Results Intervention and control students had similar systolic ( mean difference 1.7 mm Hg , 95 % CI −0.6 to 4.1 ) and diastolic ( −1.2 mm Hg , 95 % CI −3.6 to 1.3 ) blood pressure , anthropometry and well-being at outcome . Conclusion Results show that providing dark chocolate is feasible and acceptable in the school setting . For a definitive trial , the authors recommend a larger sample , endovascular function measures , and consideration of higher antioxidant ‘ dose ’ by virtue of duration and /or content BACKGROUND AND OBJECTIVES Once-daily losartan reduces BP in a dose-dependent manner and is well tolerated in hypertensive children aged 6 - 16 years . This study assessed the dose-response relationship , safety , and tolerability of losartan in hypertensive children aged 6 months to 6 years . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS This was a 12-week , r and omized , open-label , dose-ranging study , with a 2-year extension . Patients were r and omized to losartan at the following dosages : 0.1 mg/kg per day ( low ) , 0.3 mg/kg per day ( medium ) , or 0.7 mg/kg per day ( high ) . Losartan was titrated to the next dose level ( to a 1.4 mg/kg per day maximum dosage , not exceeding 100 mg/d , which was not one of the three original doses offered at r and omization ) at weeks 3 , 6 , and 9 for patients who did not attain their goal BP and were not taking the highest dose . Dose response was evaluated by analyzing the slope of change in sitting systolic BP ( SBP ; primary end point ) and diastolic BP ( DBP ; secondary end point ) after 3 weeks compared with baseline . Adverse events ( AEs ) were recorded throughout . RESULTS Of the 101 patients r and omized , 99 were included in the analysis ( low dose , n=32 ; medium dose , n=34 ; and high dose , n=33 ) . Mean sitting BP decreased from baseline in the low- , medium- , and high-dose groups by 7.3 , 7.6 , and 6.7 mmHg , respectively , for SBP and 8.2 , 5.1 , and 6.7 mmHg , respectively , for DBP after 3 weeks . No dose-response relationship was established by the slope analysis on SBP ( P=0.75 ) or DBP ( P=0.64 ) . The BP-lowering effect was observed throughout the 2-year extension . The incidence of AEs was low and comparable between groups . CONCLUSIONS Hypertensive children aged 6 months to 6 years treated with losartan 0.1 - 0.7 mg/kg per day had clinical ly significant decreases from baseline in SBP and DBP , yet no dose-response relationship was evident . Losartan , at a dosage up to 1.4 mg/kg per day , was well tolerated BACKGROUND Hypertension is a major risk factor for progressive renal failure . We assessed the long term efficacy and safety of losartan in lowering blood pressure ( BP ) and in preserving renal function in hypertensive children with chronic renal disorders . METHODS Losartan was used in 45 consecutive hypertensive children with chronic renal parenchymal disorders and mean glomerular filtration rate ( GFR ) 99.4 mL/min/1.73 m(2 ) . Of the children , 21 had hypertension alone ( H ) and 24 had both hypertension and proteinuria ( H+P ) . Assessment was done at baseline and at preselected time points : visit I , < 0.25 years ; visit II , > /=0.25 and < 0.5 year;visit III , 0.5 to 1.0 year ; and visit IV > 1 year . Both BP control and GFR were the principal outcome measures , and proteinuria was a secondary outcome measure . RESULTS The mean age was 12.85 years and follow-up was 2.42 years ( visit IV ) . Compared with baseline the systolic , diastolic , and mean arterial BP ( MABP ) fell by 9 to 12 mm Hg ( all P < .01 ) in visit I. Diastolic BP and MABP remained significantly lower in all visits ( P < .05 to .001 ) , whereas systolic BP was not statistically lower in visit II . In visit IV the proportion of normotensive children increased significantly compared with baseline ( P < .03 for systolic BP , P < .0004 for diastolic BP ) . In the H+P subgroup , optimal reduction in proteinuria ranging from 66 % to 71 % occurred in visits II to IV ( all P < .01 ) . Mean GFR declined at a rate of 9.3 mL/min/1.73 m(2 ) /year before starting losartan , and 1.4 mL/min/1.73 m(2 ) /year subsequently ( P = NS ) . On long term follow-up , GFR fell by 15.9 mL/min/1.73 m(2 ) in the H subgroup and by 5.5 mL/min/1.73 m(2 ) in the H+P subgroup ( P = NS ) . There was no correlation between BP measures and GFR or between the magnitude of BP lowering and proteinuria . Adverse effects ( one serious ) led to discontinuation of losartan in five children ( 11 % ) . CONCLUSIONS Losartan therapy was associated with prolonged and sustained antihypertensive and renoprotective benefits in children with a variety of chronic renal parenchymal disorders . Such benefit may be more pronounced in children with combined hypertension and proteinuria . The agent was well tolerated in the majority of the children Objective . To assess the safety , pharmacokinetics ( PKs ) , and blood pressure (BP)-lowering efficacy of telmisartan in pediatric ( 6 to < 18 years ) patients with hypertension . Study design . Patients with diagnosed hypertension were r and omized to 4 weeks of treatment with placebo , or with 1 of 2 nominal telmisartan dose levels ( 1 mg/kg/d or 2 mg/kg/d ) . The primary end point was change in seated systolic BP ( SBP ) from baseline to study end . Results . A total of 77 patients were r and omized and received at least 1 dose of study medication ( placebo , n = 16 ; low-dose telmisartan , n = 30 ; high-d 
    Output:
    
agent
The adverse events associated with the antihypertensive agents were mostly minor and included headaches , dizziness and upper respiratory infections .
The most data are available for c and esartan , for which there is low- quality evidence of a modest lowering effect on blood pressure .
We did not find evidence of a consistent dose response relationship for escalating doses of angiotensin receptor blockers , calcium channel blockers or angiotensin-converting enzyme inhibitors .
All agents appear safe , at least in the short term
***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 To examine the efficacy of a 3-month clinic-based behavioral nutrition intervention emphasizing a diet high in fruits , vegetables , and low fat dairy ( DASH intervention ) versus routine outpatient hospital-based nutrition care ( RC ) on diet and blood pressure ( BP ) in adolescents with elevated BP . STUDY DESIGN Fifty-seven adolescents with a clinical diagnosis of prehypertension or hypertension ( systolic BP or diastolic BP , 90(th ) to 99(th ) percentile ) were r and omly assigned to  DASH or  RC  .  SBP , DBP , 3-day diet recall , weight , and height were assessed at pretreatment , post-treatment , and 3 months later ( follow-up ) . RESULTS In completer analysis , DASH versus RC had a greater decrease in SBP z scores from baseline to post-treatment ( P < 0.01 ) and a trend for a greater decrease in SBP z scores from baseline through follow-up ( P = .07 ) . DBP z scores changed similarly for conditions from baseline through follow-up . Relative to RC , DASH had a greater increase in intake of fruits ( P < .001 ) , potassium and magnesium ( P < .01 ) , and a greater decrease in total fat ( P < .05 ) from baseline to post-treatment . From baseline through follow-up , DASH versus RC had a greater increase in low fat dairy ( P < .001 ) . CONCLUSIONS The DASH intervention proved more effective than RC in improving SBP and diet quality in adolescents with elevated BP Objective This study compares efficacy and safety of valsartan with enalapril in hypertensive children aged 6–17 years . Method This was a 12-week , r and omized , double-blind , parallel-group , active-controlled study . After a single-blind placebo run-in period ( 4–28 days ) , patients with mean sitting systolic blood pressure ( BP ) ( MSSBP ) at least 95th percentile for age , gender , and height were r and omized to receive half the assigned dose for first week , and force-titrated to full dose for 11 weeks ( ≥18 to < 35 kg – valsartan : 80 mg , enalapril : 10 mg ; ≥35 to < 80 kg – valsartan : 160 mg , enalapril : 20 mg ; ≥80 to ⩽160 kg – valsartan : 320 mg , enalapril : 40 mg ) . The primary efficacy variable was changed from baseline in MSSBP to show noninferiority of valsartan to enalapril . Other efficacy variables were changed from baseline in MSDBP , SBP control rate , and 24-h ambulatory BP parameters . Results Of 300 r and omized patients , 281 ( 94 % ) completed the study . At week 12 , MSSBP reductions were similar for valsartan and enalapril ( primary endpoint of noninferiority , P < 0.0001 ) . Least square mean BP reductions from baseline of −15.4/−9.4 mmHg were observed for valsartan compared with −14.1/−8.5 mmHg for enalapril . A similar proportion of patients achieved SBP control  ( valsartan : 67 % ; enalapril : 70 % ) . In the subset of patients who underwent ambulatory BP assessment s , valsartan provided greater reductions  than enalapril  in mean 24-h SBP  ( valsartan : −9.8 mmHg , enalapril : −7.2 mmHg : P = 0.03 ) . The overall incidence of AEs was similar ( valsartan 60 % , enalapril 58 % ) with headache , cough , and nasopharyngitis reported most frequently . Conclusions Valsartan and enalapril provided comparable BP reductions and effective BP control and were well tolerated in hypertensive children aged 6–17 years BACKGROUND AND OBJECTIVES No large , r and omized , double-blind trials in children with proteinuria treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers have previously been reported . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS This 12-week , double-blind , multinational study investigated the effects of losartan 0.7 to 1.4 mg/kg per day compared with placebo ( normotensive stratum ) or amlodipine 0.1 to 0.2 mg/kg per day up to 5 mg/d ( hypertensive stratum ) on proteinuria ( morning-void urinary protein-creatinine ratio , baseline > or = 0.3 g/g ) in 306 children up to 17 years of age . RESULTS Twelve weeks of treatment with losartan significantly reduced proteinuria compared with amlodipine/placebo : losartan -35.8 % ( 95 % confidence interval : -27.6 % to -43.1 % ) versus amlodipine/placebo 1.4 % ( 95 % confidence interval : -10.3 % to 14.5 % ) , P < or = 0.001 . Significance remained after adjustment for differences across treatment groups in change in BP ( losartan produced incremental systolic and diastolic BP reductions versus amlodipine of 5.4 and 4.6 mmHg , respectively ; and versus placebo of 3.8 and 4.0 mmHg , respectively ) . Proteinuria reduction was consistently observed in the normotensive ( -34.4 % losartan ; 2.6 % placebo ) and hypertensive ( -41.5 % losartan ; 2.4 % amlodipine ) strata , and in all prespecified subgroups , including age , gender , race , Tanner stage , weight , prior therapy with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers , as well as among the most common etiologies of proteinuria . Adverse event incidence was low and comparable in all groups . CONCLUSIONS Losartan significantly lowered proteinuria and was well tolerated after 12 weeks in children aged 1 to 17 years with proteinuria with or without hypertension , a population that has not previously been rigorously studied Background Higher adult blood pressure , even without hypertension , predicts cardiovascular outcomes , and is predicted by childhood blood pressure . Regular dark chocolate intake lowers blood pressure in adults , but effects in children are unknown . Aim To examine the feasibility of school-based provision of dark chocolate and its short-term efficacy in reducing mean group blood pressure . Methods 194 children ( aged 10–12 years ) were r and omised by class to  intervention ( 7 g dark chocolate daily for 7 weeks , n=124 ) or control ( n=70 ) groups ; 98 % and 93 % provided baseline and follow-up measurements , respectively . Results Intervention and control students had similar systolic ( mean difference 1.7 mm Hg , 95 % CI −0.6 to 4.1 ) and diastolic ( −1.2 mm Hg , 95 % CI −3.6 to 1.3 ) blood pressure , anthropometry and well-being at outcome . Conclusion Results show that providing dark chocolate is feasible and acceptable in the school setting . For a definitive trial , the authors recommend a larger sample , endovascular function measures , and consideration of higher antioxidant ‘ dose ’ by virtue of duration and /or content BACKGROUND AND OBJECTIVES Once-daily losartan reduces BP in a dose-dependent manner and is well tolerated in hypertensive children aged 6 - 16 years . This study assessed the dose-response relationship , safety , and tolerability of losartan in hypertensive children aged 6 months to 6 years . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS This was a 12-week , r and omized , open-label , dose-ranging study , with a 2-year extension . Patients were r and omized to losartan at the following dosages : 0.1 mg/kg per day ( low ) , 0.3 mg/kg per day ( medium ) , or 0.7 mg/kg per day ( high ) . Losartan was titrated to the next dose level ( to a 1.4 mg/kg per day maximum dosage , not exceeding 100 mg/d , which was not one of the three original doses offered at r and omization ) at weeks 3 , 6 , and 9 for patients who did not attain their goal BP and were not taking the highest dose . Dose response was evaluated by analyzing the slope of change in sitting systolic BP ( SBP ; primary end point ) and diastolic BP ( DBP ; secondary end point ) after 3 weeks compared with baseline . Adverse events ( AEs ) were recorded throughout . RESULTS Of the 101 patients r and omized , 99 were included in the analysis ( low dose , n=32 ; medium dose , n=34 ; and high dose , n=33 ) . Mean sitting BP decreased from baseline in the low- , medium- , and high-dose groups by 7.3 , 7.6 , and 6.7 mmHg , respectively , for SBP and 8.2 , 5.1 , and 6.7 mmHg , respectively , for DBP after 3 weeks . No dose-response relationship was established by the slope analysis on SBP ( P=0.75 ) or DBP ( P=0.64 ) . The BP-lowering effect was observed throughout the 2-year extension . The incidence of AEs was low and comparable between groups . CONCLUSIONS Hypertensive children aged 6 months to 6 years treated with losartan 0.1 - 0.7 mg/kg per day had clinical ly significant decreases from baseline in SBP and DBP , yet no dose-response relationship was evident . Losartan , at a dosage up to 1.4 mg/kg per day , was well tolerated BACKGROUND Hypertension is a major risk factor for progressive renal failure . We assessed the long term efficacy and safety of losartan in lowering blood pressure ( BP ) and in preserving renal function in hypertensive children with chronic renal disorders . METHODS Losartan was used in 45 consecutive hypertensive children with chronic renal parenchymal disorders and mean glomerular filtration rate ( GFR ) 99.4 mL/min/1.73 m(2 ) . Of the children , 21 had hypertension alone ( H ) and 24 had both hypertension and proteinuria ( H+P ) . Assessment was done at baseline and at preselected time points : visit I , < 0.25 years ; visit II , > /=0.25 and < 0.5 year;visit III , 0.5 to 1.0 year ; and visit IV > 1 year . Both BP control and GFR were the principal outcome measures , and proteinuria was a secondary outcome measure . RESULTS The mean age was 12.85 years and follow-up was 2.42 years ( visit IV ) . Compared with baseline the systolic , diastolic , and mean arterial BP ( MABP ) fell by 9 to 12 mm Hg ( all P < .01 ) in visit I. Diastolic BP and MABP remained significantly lower in all visits ( P < .05 to .001 ) , whereas systolic BP was not statistically lower in visit II . In visit IV the proportion of normotensive children increased significantly compared with baseline ( P < .03 for systolic BP , P < .0004 for diastolic BP ) . In the H+P subgroup , optimal reduction in proteinuria ranging from 66 % to 71 % occurred in visits II to IV ( all P < .01 ) . Mean GFR declined at a rate of 9.3 mL/min/1.73 m(2 ) /year before starting losartan , and 1.4 mL/min/1.73 m(2 ) /year subsequently ( P = NS ) . On long term follow-up , GFR fell by 15.9 mL/min/1.73 m(2 ) in the H subgroup and by 5.5 mL/min/1.73 m(2 ) in the H+P subgroup ( P = NS ) . There was no correlation between BP measures and GFR or between the magnitude of BP lowering and proteinuria . Adverse effects ( one serious ) led to discontinuation of losartan in five children ( 11 % ) . CONCLUSIONS Losartan therapy was associated with prolonged and sustained antihypertensive and renoprotective benefits in children with a variety of chronic renal parenchymal disorders . Such benefit may be more pronounced in children with combined hypertension and proteinuria . The agent was well tolerated in the majority of the children Objective . To assess the safety , pharmacokinetics ( PKs ) , and blood pressure (BP)-lowering efficacy of telmisartan in pediatric ( 6 to < 18 years ) patients with hypertension . Study design . Patients with diagnosed hypertension were r and omized to 4 weeks of treatment with placebo , or with 1 of 2 nominal telmisartan dose levels ( 1 mg/kg/d or 2 mg/kg/d ) . The primary end point was change in seated systolic BP ( SBP ) from baseline to study end . Results . A total of 77 patients were r and omized and received at least 1 dose of study medication ( placebo , n = 16 ; low-dose telmisartan , n = 30 ; high-d 
    Output:
    