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: In a 6-month prospect i ve study , the efficacy and safety of urapidil and nifedipine in an outpatient population with hypertensive urgencies ( systolic blood pressure > 200 mm Hg ; diastolic blood pressure > 110 mm Hg ) was investigated . Response to treatment was defined as a stable reduction of systolic blood pressure below 180 mm Hg and diastolic blood pressure below 100 mm Hg 15 minutes after application of a single dose of either 25 mg urapidil intravenously ( N = 26 ) or 10 mg nifedipine sublingually ( N = 27 ) . If the blood pressure was still elevated , a second dose of 10 mg nifedipine or 12.5 mg urapidil was given , and blood pressure response was evaluated 15 minutes after application of the second dose according to the aforementioned criteria s. After the first application of nifedipine , 19 ( 70 % ) responders have been observed . Eight patients needed an additional 10 mg of nifedipine . In four of these patients , no reduction of blood pressure was observed after a second dose of nifedipine . In contrast , 24 ( 92 % ) patients responded well to the first application of 25 mg of urapidil . Two patients required a second dose of 12.5 mg of urapidil , but no nonresponder to urapidil was observed . No severe side-effects were noted in both groups . Intravenous urapidil is a highly effective drug in the treatment of hypertensive urgencies and is more effective than sublingual nifedipine , because the number of patients treated successfully was significantly higher To determine whether nitroglycerin is just as effective as nifedipine in lowering the blood pressure in excessive hypertension and hypertensive crisis , two groups of 20 patients received in r and om sequence either 1.2 mg of nitroglycerin sublingually or a 10 mg nifedipine capsule , which was chewed and swallowed . The blood pressure fell after 5 min in the nitroglycerin group from 211/122 mm Hg to 171/95 mm Hg and after nifedipine from 210/118 to 185/102 mm Hg . The greater effect of nitroglycerin results from faster absorption through the oral mucosa than through the small intestinal mucosa where nifedipine is primarily absorbed . After 15 to 20 min a satisfactory reduction in blood pressure was reached in both groups : 157/91 and 158/92 mm Hg , respectively . After 30 min the heart rate in the nitroglycerin group had decreased from 83 to 80/min , but in the nifedipine group it had increased from 84 to 90/min . The reduction in blood pressure persisted up to 6 h. No significant difference in side-effects was determined . Since a hypertensive crisis is usually accompanied by left-ventricular failure , pulmonary edema or angina pectoris and infa rct ion , and nitroglycerin has been definitively shown to positively influence these conditions , preference should be given to nitroglycerin in the treatment of hypertensive crisis Twenty patients with acute severe hypertension were r and omised to therapy with either nifedipine capsules ( 10 mg ) or captopril tablets ( 25 mg ) given sublingually and the blood pressure recorded for 240 minutes . Oral monotherapy with either agent followed for 3 weeks , then the agents were combined for a further 2 weeks and in the final 6 weeks of the trial a beta-blocker and diuretic were added , if needed . Thirteen patients completed the trial . The major results were : ( i ) nifedipine decreased blood pressure more rapidly than captopril 60 minutes after first ingestion but at 240 minutes equal degrees of fall in blood pressure had been obtained ; ( ii ) neither agent given as sustained monotherapy was able to reduce blood pressure adequately , although nifedipine was better than captopril ; and ( iii ) combination therapy with both agents was conspicuously successful in achieving reduction in blood pressure . It is suggested that combination nifedipine-captopril therapy be subject to a formal trial for early therapy in acute severe hypertension Sublingual nifedipine is commonly used in hypertensive crisis , however , it may result in several adverse effects such as reflex tachycardia , headache , and flushing . Research is continuing to find a new drug that has the same efficiency and fewer side effects . Sublingual captopril , a new preparation of angiotensin-converting enzyme inhibitor , lowers blood pressure . It is not known whether it is effective in these emergent clinical setting s. Therefore we design ed a r and omized , double-blind study to compare the efficacy and safety of those two drugs in hypertensive crisis . Eighty patients ( 32 male and 48 female ) with hypertensive crisis were included in the study ; their mean age was 43.4 ± 7.9 years . Nifedipine 10 mg was given sublingually to 34 and captopril 25 mg to 46 patients r and omly . There was no difference between the two drugs with respect to their antihypertensive effect . Heart rate significantly dropped ( p<0.01 and p<0.001 ) in the patients taking captopril , but no changes were observed in the patients taking nifedipine . Twenty-three of 34 patients taking nifedipine  encountered adverse effects . Adverse effects were observed in only three patients taking captopril ( p<0.001 ) . Sublingual captopril is as effective as and has less side effects  than sublingual nifedipine . Because sublingual captopril has fewer side effects , it may be safer than nifedipine in the treatment of hypertensive crisis We examined the antihypertensive efficacy of : ( 1 ) sublingual-oral single doses of captopril ( 25 mg ) and nifedipine-capsules ( 10 mg ) in 9 + 9 white patients and in 9 + 8 black patients with hypertensive crisis ; and ( 2 ) a single oral dose of the slow-acting preparation of nifedipine-retard  ( 20 mg ) in another 10 black patients . Blood pressure ( BP ) was assessed at 10 min intervals for 6 h after administration . After 6 h , the BP falls induced by these drugs were still significantly lower than the baseline placebo values . Hypotensive effect of nifedipine-capsules was established more rapidly than that of captopril in both white and black patients , and of nifedipine-retard in black patients . Considering the area under the curve of BP values during the 6-h treatment , the overall hypotensive effect of nifedipine-capsules was similar to captopril in white patients , but significantly more pronounced than captopril and nifedipine-retard in black patients . In white patients similar maximal drops of BP ( mean ± s.e.m . ) were obtained with nifedipine-capsules ( 71 ± 4/52 ± 4 mm Hg ) and with captopril ( 69 ± 4/50 ± 3 mm Hg ) . In black patients the maximal drop of BP of nifedipine-capsules ( 70 ± 4/52 ± 4 mm Hg ) was greater ( P < 0.02 ) than that of captopril ( 48 ± 4/32 ± 3 mm hg ) but similar to that of nifedipine-retard ( 71 ± 4/49 ± 4 mm hg ) . however , in contrast to nifedipine-capsules and captopril , nifedipine-retard produced a slower drop in bp . the time of peak drop in bp of both nifedipine-capsules and captopril occurred within the first 2 h whereas with nifedipine-retard it occurred only between 4 and 6 h after administration . fewer patients reported side effects with nifedipine-retard as compared with the other two preparations . we conclude that single doses of captopril and nifedipine  reduces bp for at least 6 h in both white and black patients with hypertensive crisis , but nifedipine is more potent than captopril in black patients . the slow release form of nifedipine-retard  effectively and safely lowers bp while achieving a rapid enough effect without the critical rapid falls in bp that occur with nifedipine-capsules Fifty two patients of severe hypertension , diastolic blood pressure > or = 115 mmHg , with or without acute complications , were treated with sublingual nifedipine 10 mg or sublingual captopril 25 mg in a r and omized prospect i ve in patient study with careful clinical monitoring . Both the drugs were safe and effective in rapidly lowering blood pressure .  Nifedipine appeared to be superior to captopril with earlier onset of action , greater magnitude of response and longer duration of action . No significant side effects were observed in either of the two groups In order to determine the prevalence of arterial hypertension and clinical presentation of the hypertensive crisis , as well as the need and efficacy of treatment , 3626 patients who were seen at an Emergency care Unit during a period of 37 r and omly chosen days in a total time period of three months , have been studied . Two hundred and fifty one patients presented arterial hypertension , defined as a systolic arterial pressure above 160 mmHg and /or diastolic above 95 mmHG , which represents 6,92 % of medical emergencies and 1.79 % of total emergencies . Only 104 patients ( 2.86 % ) seeked help for some pathology related to hypertension , of whom 49 ( 19.5 % of hypertense patients ) presented as a hypertensive emergency , being the acute lung edema and unstable angina the most frequently encountered emergencies . Nifedipine was the most frequently used drug in both groups and managed to control pressure levels in almost 90 % of patients with a hypertensive emergency in a mean time of less than one hour OBJECTIVE This study was design ed to show the effects of sublingually administered nifedipine and captopril on middle cerebral arterial blood flow during hypertensive crisis in the emergency department . METHODS AND RESULTS Transcranial Doppler ultrasonography ( TCD ) was performed on the patients fulfilling the criteria ( 15 patients given captopril , 13 patients given nifedipine , mean ( + /-SD ) age 56 + /- 11 and 54 + /- 10 years , respectively ) . Then , patients were r and omized into sublingually administered captopril or nifedipine groups and after the drug administration , TCD was repeated . Initial systolic and diastolic blood pressures were 200 + /- 21/125 + /- 21 mmHg in the captopril group and 199 + /- 17/ 123 + /- 20 mmHg in the nifedipine group . There was no significant difference between antihypertensive effects of the drugs after initiation of treatment . Before the treatment with captopril , middle cerebral artery ( MCA ) flow velocities ( Vm ) and pulsatility index ( PI ) were 76.74 + /- 6.38 cm/s and 1.18 + /- 0.09 , respectively . The values after the treatment with captopril were 78.21 + /- 5.24cm/s ( p < 0.05 ) and 0.92 + /- 0.08 ( p < 0.001 ) , respectively . Before the treatment with nifedipine , Vm and PIs were 64.73 + /- 5.11 cm/s and 1.14 + /- 0.18 , respectively . After the treatment with nifedipine , Vm was 60.04 + /- 5.36 cm/s ( p < 0.01 ) and PI was 1.21 + /- 0.09 ( p < 0.01 ) . CONCLUSION After treatment with captopril , PIs were decreased to normal limits but in the group treated with nifedipine , PIs increased to more pathological values . These results showed that we should reconsider the use of nifedipine in the emergency departments as an antihypertensive agent in hypertensive attack treatment & NA ; This study estimated the efficacy of sublingual nifedipine 10 mg vs. sublingual lacidipine 4 mg in the management of hypertensive crises . We studied 40 patients with diastolic blood pressure ≥120 mm Hg , who were divided into two groups of 20 . Blood pressure and heart rate were assessed in the recumbent position before treatment and after 30 , 120 , and 240 min . Comparison of the effectiveness of these drugs was analyzed by Student 's t test . Both drugs tested revealed a statistically significant hypotensive effect on diastolic and systolic blood pressure , and few side effects . Compared with lacidipine , nifedipine had a greater hypotensive effect on diastolic and systolic blood pressure in the first 30 min and on the diastolic blood pressure after the first 120 min . However , the hypotensive effect of lacidipine is statistically significant . After 4 h , both drugs showed a similar efficacy without significant statistical variations . We concluded that in the management of hypertensive crises the use of each of these drugs can have a particular range : nifedipine can be used when a pronounced and rapid blood pressure decrement is necessary , whereas lacidipine can be used when a more gradual effect is preferable Summary To determine whether nitroglycerin is as effective as nifedipine in lowering the blood pressure in severe hypert 
    Output:
    
agent
There is important evidence in favor of the use of angiotensin-converting enzyme inhibitors for treating hypertensive urgencies , compared with calcium channel blockers , considering the better effectiveness and the lower frequency of adverse effects ( like headache and flushing )
***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: In a 6-month prospect i ve study , the efficacy and safety of urapidil and nifedipine in an outpatient population with hypertensive urgencies ( systolic blood pressure > 200 mm Hg ; diastolic blood pressure > 110 mm Hg ) was investigated . Response to treatment was defined as a stable reduction of systolic blood pressure below 180 mm Hg and diastolic blood pressure below 100 mm Hg 15 minutes after application of a single dose of either 25 mg urapidil intravenously ( N = 26 ) or 10 mg nifedipine sublingually ( N = 27 ) . If the blood pressure was still elevated , a second dose of 10 mg nifedipine or 12.5 mg urapidil was given , and blood pressure response was evaluated 15 minutes after application of the second dose according to the aforementioned criteria s. After the first application of nifedipine , 19 ( 70 % ) responders have been observed . Eight patients needed an additional 10 mg of nifedipine . In four of these patients , no reduction of blood pressure was observed after a second dose of nifedipine . In contrast , 24 ( 92 % ) patients responded well to the first application of 25 mg of urapidil . Two patients required a second dose of 12.5 mg of urapidil , but no nonresponder to urapidil was observed . No severe side-effects were noted in both groups . Intravenous urapidil is a highly effective drug in the treatment of hypertensive urgencies and is more effective than sublingual nifedipine , because the number of patients treated successfully was significantly higher To determine whether nitroglycerin is just as effective as nifedipine in lowering the blood pressure in excessive hypertension and hypertensive crisis , two groups of 20 patients received in r and om sequence either 1.2 mg of nitroglycerin sublingually or a 10 mg nifedipine capsule , which was chewed and swallowed . The blood pressure fell after 5 min in the nitroglycerin group from 211/122 mm Hg to 171/95 mm Hg and after nifedipine from 210/118 to 185/102 mm Hg . The greater effect of nitroglycerin results from faster absorption through the oral mucosa than through the small intestinal mucosa where nifedipine is primarily absorbed . After 15 to 20 min a satisfactory reduction in blood pressure was reached in both groups : 157/91 and 158/92 mm Hg , respectively . After 30 min the heart rate in the nitroglycerin group had decreased from 83 to 80/min , but in the nifedipine group it had increased from 84 to 90/min . The reduction in blood pressure persisted up to 6 h. No significant difference in side-effects was determined . Since a hypertensive crisis is usually accompanied by left-ventricular failure , pulmonary edema or angina pectoris and infa rct ion , and nitroglycerin has been definitively shown to positively influence these conditions , preference should be given to nitroglycerin in the treatment of hypertensive crisis Twenty patients with acute severe hypertension were r and omised to therapy with either nifedipine capsules ( 10 mg ) or captopril tablets ( 25 mg ) given sublingually and the blood pressure recorded for 240 minutes . Oral monotherapy with either agent followed for 3 weeks , then the agents were combined for a further 2 weeks and in the final 6 weeks of the trial a beta-blocker and diuretic were added , if needed . Thirteen patients completed the trial . The major results were : ( i ) nifedipine decreased blood pressure more rapidly than captopril 60 minutes after first ingestion but at 240 minutes equal degrees of fall in blood pressure had been obtained ; ( ii ) neither agent given as sustained monotherapy was able to reduce blood pressure adequately , although nifedipine was better than captopril ; and ( iii ) combination therapy with both agents was conspicuously successful in achieving reduction in blood pressure . It is suggested that combination nifedipine-captopril therapy be subject to a formal trial for early therapy in acute severe hypertension Sublingual nifedipine is commonly used in hypertensive crisis , however , it may result in several adverse effects such as reflex tachycardia , headache , and flushing . Research is continuing to find a new drug that has the same efficiency and fewer side effects . Sublingual captopril , a new preparation of angiotensin-converting enzyme inhibitor , lowers blood pressure . It is not known whether it is effective in these emergent clinical setting s. Therefore we design ed a r and omized , double-blind study to compare the efficacy and safety of those two drugs in hypertensive crisis . Eighty patients ( 32 male and 48 female ) with hypertensive crisis were included in the study ; their mean age was 43.4 ± 7.9 years . Nifedipine 10 mg was given sublingually to 34 and captopril 25 mg to 46 patients r and omly . There was no difference between the two drugs with respect to their antihypertensive effect . Heart rate significantly dropped ( p<0.01 and p<0.001 ) in the patients taking captopril , but no changes were observed in the patients taking nifedipine . Twenty-three of 34 patients taking nifedipine  encountered adverse effects . Adverse effects were observed in only three patients taking captopril ( p<0.001 ) . Sublingual captopril is as effective as and has less side effects  than sublingual nifedipine . Because sublingual captopril has fewer side effects , it may be safer than nifedipine in the treatment of hypertensive crisis We examined the antihypertensive efficacy of : ( 1 ) sublingual-oral single doses of captopril ( 25 mg ) and nifedipine-capsules ( 10 mg ) in 9 + 9 white patients and in 9 + 8 black patients with hypertensive crisis ; and ( 2 ) a single oral dose of the slow-acting preparation of nifedipine-retard  ( 20 mg ) in another 10 black patients . Blood pressure ( BP ) was assessed at 10 min intervals for 6 h after administration . After 6 h , the BP falls induced by these drugs were still significantly lower than the baseline placebo values . Hypotensive effect of nifedipine-capsules was established more rapidly than that of captopril in both white and black patients , and of nifedipine-retard in black patients . Considering the area under the curve of BP values during the 6-h treatment , the overall hypotensive effect of nifedipine-capsules was similar to captopril in white patients , but significantly more pronounced than captopril and nifedipine-retard in black patients . In white patients similar maximal drops of BP ( mean ± s.e.m . ) were obtained with nifedipine-capsules ( 71 ± 4/52 ± 4 mm Hg ) and with captopril ( 69 ± 4/50 ± 3 mm Hg ) . In black patients the maximal drop of BP of nifedipine-capsules ( 70 ± 4/52 ± 4 mm Hg ) was greater ( P < 0.02 ) than that of captopril ( 48 ± 4/32 ± 3 mm hg ) but similar to that of nifedipine-retard ( 71 ± 4/49 ± 4 mm hg ) . however , in contrast to nifedipine-capsules and captopril , nifedipine-retard produced a slower drop in bp . the time of peak drop in bp of both nifedipine-capsules and captopril occurred within the first 2 h whereas with nifedipine-retard it occurred only between 4 and 6 h after administration . fewer patients reported side effects with nifedipine-retard as compared with the other two preparations . we conclude that single doses of captopril and nifedipine  reduces bp for at least 6 h in both white and black patients with hypertensive crisis , but nifedipine is more potent than captopril in black patients . the slow release form of nifedipine-retard  effectively and safely lowers bp while achieving a rapid enough effect without the critical rapid falls in bp that occur with nifedipine-capsules Fifty two patients of severe hypertension , diastolic blood pressure > or = 115 mmHg , with or without acute complications , were treated with sublingual nifedipine 10 mg or sublingual captopril 25 mg in a r and omized prospect i ve in patient study with careful clinical monitoring . Both the drugs were safe and effective in rapidly lowering blood pressure .  Nifedipine appeared to be superior to captopril with earlier onset of action , greater magnitude of response and longer duration of action . No significant side effects were observed in either of the two groups In order to determine the prevalence of arterial hypertension and clinical presentation of the hypertensive crisis , as well as the need and efficacy of treatment , 3626 patients who were seen at an Emergency care Unit during a period of 37 r and omly chosen days in a total time period of three months , have been studied . Two hundred and fifty one patients presented arterial hypertension , defined as a systolic arterial pressure above 160 mmHg and /or diastolic above 95 mmHG , which represents 6,92 % of medical emergencies and 1.79 % of total emergencies . Only 104 patients ( 2.86 % ) seeked help for some pathology related to hypertension , of whom 49 ( 19.5 % of hypertense patients ) presented as a hypertensive emergency , being the acute lung edema and unstable angina the most frequently encountered emergencies . Nifedipine was the most frequently used drug in both groups and managed to control pressure levels in almost 90 % of patients with a hypertensive emergency in a mean time of less than one hour OBJECTIVE This study was design ed to show the effects of sublingually administered nifedipine and captopril on middle cerebral arterial blood flow during hypertensive crisis in the emergency department . METHODS AND RESULTS Transcranial Doppler ultrasonography ( TCD ) was performed on the patients fulfilling the criteria ( 15 patients given captopril , 13 patients given nifedipine , mean ( + /-SD ) age 56 + /- 11 and 54 + /- 10 years , respectively ) . Then , patients were r and omized into sublingually administered captopril or nifedipine groups and after the drug administration , TCD was repeated . Initial systolic and diastolic blood pressures were 200 + /- 21/125 + /- 21 mmHg in the captopril group and 199 + /- 17/ 123 + /- 20 mmHg in the nifedipine group . There was no significant difference between antihypertensive effects of the drugs after initiation of treatment . Before the treatment with captopril , middle cerebral artery ( MCA ) flow velocities ( Vm ) and pulsatility index ( PI ) were 76.74 + /- 6.38 cm/s and 1.18 + /- 0.09 , respectively . The values after the treatment with captopril were 78.21 + /- 5.24cm/s ( p < 0.05 ) and 0.92 + /- 0.08 ( p < 0.001 ) , respectively . Before the treatment with nifedipine , Vm and PIs were 64.73 + /- 5.11 cm/s and 1.14 + /- 0.18 , respectively . After the treatment with nifedipine , Vm was 60.04 + /- 5.36 cm/s ( p < 0.01 ) and PI was 1.21 + /- 0.09 ( p < 0.01 ) . CONCLUSION After treatment with captopril , PIs were decreased to normal limits but in the group treated with nifedipine , PIs increased to more pathological values . These results showed that we should reconsider the use of nifedipine in the emergency departments as an antihypertensive agent in hypertensive attack treatment & NA ; This study estimated the efficacy of sublingual nifedipine 10 mg vs. sublingual lacidipine 4 mg in the management of hypertensive crises . We studied 40 patients with diastolic blood pressure ≥120 mm Hg , who were divided into two groups of 20 . Blood pressure and heart rate were assessed in the recumbent position before treatment and after 30 , 120 , and 240 min . Comparison of the effectiveness of these drugs was analyzed by Student 's t test . Both drugs tested revealed a statistically significant hypotensive effect on diastolic and systolic blood pressure , and few side effects . Compared with lacidipine , nifedipine had a greater hypotensive effect on diastolic and systolic blood pressure in the first 30 min and on the diastolic blood pressure after the first 120 min . However , the hypotensive effect of lacidipine is statistically significant . After 4 h , both drugs showed a similar efficacy without significant statistical variations . We concluded that in the management of hypertensive crises the use of each of these drugs can have a particular range : nifedipine can be used when a pronounced and rapid blood pressure decrement is necessary , whereas lacidipine can be used when a more gradual effect is preferable Summary To determine whether nitroglycerin is as effective as nifedipine in lowering the blood pressure in severe hypert 
    Output:
    