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: BACKGROUND Because of poor patient compliance and clinical inertia , hypertension control rates remain poor . Home blood-pressure measurements ( HBPM ) improve compliance of patients and achievement of blood pressure ( BP ) targets . However , few studies have evaluated self-BP management by patients . METHODS In a multicenter , prospect i ve , single-group , open-label pilot study of 111 patients whose hypertension was uncontrolled despite monotherapy , we studied satisfaction with , and feasibility of , HBPM and self-titration of antihypertensive treatment using telemedicine for compliance , efficacy , and safety . After education ( protocol , action plan , and use of the HBPM device ) , patients performed a sequence of HBPM every 2 weeks for 8 weeks . Following a stepwise approach , treatment was increased by the patient at weeks 4 and 6 if average HBPM values exceeded predefined limits . For each titration , the patient informed the Core Center by telemedicine , but BP values were transferred automatically . RESULTS Overall , 80 % of patients were satisfied ( 58 % ) or very satisfied ( 23 % ) with the program ( 95 % confidence interval , 73 % to 87 % ) . Regarding compliance , 78 % of patients fully complied with self-measurement , and just over 71 % titrated their treatment adequately . Physicians were satisfied ( 52 % ) or very satisfied ( 22 % ) with the program . Between the first and final visits ( at week 8) , office systolic/diastolic BP ( mean + /- SD ) decreased significantly from 151 + /- 9/91 + /- 6 to 143 + /- 13/84 + /- 11 mmHg . During the trial ,  HBPM  ( mean + /- SD ) decreased significantly from 149 + /- 13/86 + /- 12 to 138 + /- 16/81 + /- 10 mmHg . No significant safety issues were reported . CONCLUSIONS This innovative approach to the management of hypertension , combining self-measurement and self-titration , is feasible , well-accepted by both patients and physicians , and safe In underserved population s , inadequate surveillance and treatment allows hypertension to persist until actual cardiovascular events occur . Thus , we developed an Internet-based telemedicine system to address the suboptimal control of hypertension and other modifiable risk factors . To minimize cost , the subjects used home monitors for blood pressure ( BP ) measurements and entered these values into the telemedicine system . We hypothesized that patients could accurately measure their BP and transmit these values via a telemedicine system . Inner city and rural subjects ( N = 464 ; 42 % African-American or Hispanic ) with 10 % or greater 10-year risk of cardiovascular disease and with treatable risk factors were r and omized into two groups , control group ( CG ) and telemedicine group ( TG ) . Each subject received a home sphygmomanometer with memory . The TG recorded and entered BP at least weekly . During office visits , the BP meters were downloaded and recorded BP compared to BP values transmitted via telemedicine . The telemedicine ( T ) BP values were similar to the meter recorded ( R ) values ( T : systolic/diastolic BP 133.4 + /- 11.1/77.5 + /- 6.8 mm Hg , and R : systolic/diastolic BP 136.4 + /- 11.9.4/79.7 + /- 7.5 mm Hg ) . The percent error was < 1 % for both systolic ( -0.02 + /- 0.04 % ) and diastolic ( -0.03 + /- 0.04 % ) BP . Lastly , the telemedicine BP values were similar to the office ( O ) BP values for systolic and diastolic BP ( T : systolic/diastolic BP 133.4 + /- 11.1/77.5 + /- 6.8 mm Hg , and O : systolic/diastolic BP 136.3 + /- 20.5/78.1 + /- 10.5 mm Hg ) . In underserved population s , this inexpensive approach of patients using a home monitor and entering these values into a telemedicine system provided accurate BP data The purpose of this study was to determine if ambulatory blood pressure measurement predicted total and cardiovascular mortality over and beyond clinic blood pressure measurement and other cardiovascular risk factors ; 5292 untreated hypertensive patients referred to a single blood pressure clinic who had clinic and ambulatory blood pressure measurement at baseline were followed up in a prospect i ve study of mortality outcome . Multiple Cox regression was used to model time to total and cause-specific mortality for ambulatory blood pressure measurement while adjusting for clinic blood pressure measurement and other risk factors at baseline . There were 646 deaths ( of which 389 were cardiovascular ) during a median follow-up period of 8.4 years . With adjustment for gender , age , risk indices , and clinic blood pressure , higher mean values of ambulatory blood pressure were independent predictors for cardiovascular mortality . The relative hazard ratio for each 10-mm Hg increase in systolic blood pressure was 1.12 ( 1.06 to 1.18 ; P<0.001 ) for daytime and 1.21 ( 1.15 to 1.27 ; P<0.001 ) for nighttime systolic blood pressure . The hazard ratios for each 5-mm Hg increase in diastolic blood pressure were 1.02 ( 0.99 to 1.07 ; P = NS ) for daytime and 1.09 ( 1.04 to 1.13 ; P<0.01 ) for nighttime diastolic pressures . The hazard ratios for nighttime ambulatory blood pressure remained significant after adjustment for daytime ambulatory blood pressure . These results have 2 important clinical messages : ambulatory measurement of blood pressure is superior to clinic measurement in predicting cardiovascular mortality , and nighttime blood pressure is the most potent predictor of outcome Aim . To compare the effectiveness of antihypertensive treatment based on telemonitoring of home blood pressure ( BP ) and conventional monitoring of office BP . Methods . Hypertensive patients ( n = 236 ) participated in a r and omized , controlled study . In the intervention group , antihypertensive treatment was based on home BP monitoring . BP readings were registered by a PDA and automatically transmitted to a server , by which the patient and doctor could communicate . In the control group , patients received usual care with office visits to adjust antihypertensive treatment as needed . Primary outcome was difference in systolic daytime ambulatory BP monitoring ( ABPM ) change between baseline and 6 months . Results . In both groups , systolic daytime ABPM decreased significantly from baseline to follow‐up . The decrease in systolic daytime ABPM was −11.9 mmHg in the intervention group and −9.6 mmHg in the control group ( mean difference −2.3 [ 95 % CI −6.1 to −1.5 ] , p = 0.225 ) . The likelihood of daytime ABPM normalization was similar in the two groups [ 32/113 ( 28 % ) vs 46/123 ( 37 % ) , p = 0.139 ] . Conclusion . Antihypertensive treatment based on telemonitoring of home BP was as effective as usual monitoring of office BP with regards to reduction of BP . Trial registration : Clinical Trials.gov identifier : NCT00282334 BACKGROUND Control of blood pressure is a key component of cardiovascular disease prevention , but is difficult to achieve and until recently has been the sole preserve of health professionals . This study assessed whether self-management by people with poorly controlled hypertension result ed in better blood pressure control compared with usual care . METHODS This r and omised controlled trial was undertaken in 24 general practice s in the UK . Patients aged 35 - 85 years were eligible for enrolment if they had blood pressure more than 140/90 mm Hg despite antihypertensive treatment and were willing to self-manage their hypertension . Participants were r and omly assigned in a 1:1 ratio to self-management , consisting of self-monitoring of blood pressure and self-titration of antihypertensive drugs , combined with telemonitoring of home blood pressure measurements or to usual care . R and omisation was done by use of a central web-based system and was stratified by general practice with minimisation for sex , baseline systolic blood pressure , and presence or absence of diabetes or chronic kidney disease . Neither participants nor investigators were masked to group assignment . The primary endpoint was change in mean systolic blood pressure between baseline and each follow-up point ( 6 months and 12 months ) . All r and omised patients who attended follow-up visits at 6 months and 12 months and had complete data for the primary outcome were included in the analysis , without imputation for missing data . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N17585681 . FINDINGS 527 participants were r and omly assigned to self-management ( n=263 ) or control ( n=264 ) , of whom 480 ( 91 % ; self-management , n=234 ; control , n=246 ) were included in the primary analysis . Mean systolic blood pressure decreased by 12.9 mm Hg ( 95 % CI 10.4 - 15.5 ) from baseline to 6 months in the self-management group and by 9.2 mm Hg ( 6.7 - 11.8 ) in the control group ( difference between groups 3.7 mm Hg , 0.8 - 6.6 ; p=0.013 ) . From baseline to 12 months , systolic blood pressure decreased by 17.6 mm Hg ( 14.9 - 20.3 ) in the self-management group and by 12.2 mm Hg ( 9.5 - 14.9 ) in the control group ( difference between groups 5.4 mm Hg , 2.4 - 8.5 ; p=0.0004 ) . Frequency of most side-effects did not differ between groups , apart from leg swelling ( self-management , 74 patients [ 32 % ] ; control , 55 patients [ 22 % ] ; p=0.022 ) . INTERPRETATION Self-management of hypertension in combination with telemonitoring of  blood pressure measurements represents an important new addition to control of hypertension in primary care . FUNDING Department of Health Policy Research Programme , National Coordinating Centre for Research Capacity Development , and Midl and s Research Practice s Consortium PURPOSE The present study evaluated whether an intervention using a short message service ( SMS ) by cellular phone and Internet would improve blood pressure , weight control , and serum lipids of obese patients with hypertension during 8 weeks . METHODS This is a quasi-experimental design with pre- and follow-up tests . Participants were recruited from the family medicine outpatient department of tertiary care hospital located in an urban city of South Korea . Twenty-eight patients were assigned to an intervention group and 21 to a control group . The goal of intervention was to bring blood pressure , body weight , and serum lipids levels close to normal ranges . Patients in the intervention group were requested to record their blood pressure and body weight in a weekly web based diary through the Internet or by cellular phones . The research ers sent optimal recommendations as an intervention to each patient , by both cellular phone and Internet weekly . The intervention was applied for 8 weeks . RESULTS Systolic ( SBP ) and diastolic blood pressures ( DBP ) significantly decreased by 9.1 and 7.2 mmHg respectively at 8 weeks from the baseline in the intervention group ( p<0.05 ) . However , after 8 weeks from the baseline both SBP and DBP in the control group had not changed significantly . Yet , There were significant mean decreases in body weight and waist circumference by 1.6 kg ( p<0.05 ) and 2.8 cm ( p<0.05 ) in the intervention group , respectively . In the control group increases in body weight and waist circumference ( p<0.05 ) mean changes were also significant . High density lipoprotein cholesterol ( HDL-C ) significantly increased , with a mean change of 3.7 mg/dl at 8 weeks from baseline in the intervention group ( p<0.05 ) . The mean change of HDL-C in the control group was , however , not significant . CONCLUSION During 8 weeks using this web-based intervention by way of cellular phone and Internet SMS improved blood pressure , body weight , waist circumference , and HDL-C in patients with obese hypertension This study was aim ed at assessing the diagnostic accuracy of telemedicine among hypertensive patients . This was a cross-sectional analysis of patients attending a hypertension clinic over a year-long study . Patients were seen both by telemedicine and in-person on the same day with order of the encounters r and omly determined . A telemedicine system , which utilized phone lines , was employed . For each type of encounter , whether telemedicine ( TM ) or in-person ( IP ) , clinical data on blood pressure ( BP ) control as well as physician ordering patterns were collected . Receiver Operator Characteristic ( ROC ) curves were used to assess the validity of TM as compared to IP in the assessment of uncontrolled hypertension .  Sixty-two patients participated result ing in 107-paired visits over the year-long study period . The mean age of the 62 participants was 67.1 + /- 11.4 years ; 56.6 % were men . ROC curves for detecting elevated mean blood pressure provided an area under the curve ( 
    Output:
    
agent
TC led to a greater decrease in systolic and diastolic BP  than UC .
The differences between TC and UC for systolic BP tend to become larger when no treatment modification is applied .
TC seems a valuable tool for hypertension management
***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: BACKGROUND Because of poor patient compliance and clinical inertia , hypertension control rates remain poor . Home blood-pressure measurements ( HBPM ) improve compliance of patients and achievement of blood pressure ( BP ) targets . However , few studies have evaluated self-BP management by patients . METHODS In a multicenter , prospect i ve , single-group , open-label pilot study of 111 patients whose hypertension was uncontrolled despite monotherapy , we studied satisfaction with , and feasibility of , HBPM and self-titration of antihypertensive treatment using telemedicine for compliance , efficacy , and safety . After education ( protocol , action plan , and use of the HBPM device ) , patients performed a sequence of HBPM every 2 weeks for 8 weeks . Following a stepwise approach , treatment was increased by the patient at weeks 4 and 6 if average HBPM values exceeded predefined limits . For each titration , the patient informed the Core Center by telemedicine , but BP values were transferred automatically . RESULTS Overall , 80 % of patients were satisfied ( 58 % ) or very satisfied ( 23 % ) with the program ( 95 % confidence interval , 73 % to 87 % ) . Regarding compliance , 78 % of patients fully complied with self-measurement , and just over 71 % titrated their treatment adequately . Physicians were satisfied ( 52 % ) or very satisfied ( 22 % ) with the program . Between the first and final visits ( at week 8) , office systolic/diastolic BP ( mean + /- SD ) decreased significantly from 151 + /- 9/91 + /- 6 to 143 + /- 13/84 + /- 11 mmHg . During the trial ,  HBPM  ( mean + /- SD ) decreased significantly from 149 + /- 13/86 + /- 12 to 138 + /- 16/81 + /- 10 mmHg . No significant safety issues were reported . CONCLUSIONS This innovative approach to the management of hypertension , combining self-measurement and self-titration , is feasible , well-accepted by both patients and physicians , and safe In underserved population s , inadequate surveillance and treatment allows hypertension to persist until actual cardiovascular events occur . Thus , we developed an Internet-based telemedicine system to address the suboptimal control of hypertension and other modifiable risk factors . To minimize cost , the subjects used home monitors for blood pressure ( BP ) measurements and entered these values into the telemedicine system . We hypothesized that patients could accurately measure their BP and transmit these values via a telemedicine system . Inner city and rural subjects ( N = 464 ; 42 % African-American or Hispanic ) with 10 % or greater 10-year risk of cardiovascular disease and with treatable risk factors were r and omized into two groups , control group ( CG ) and telemedicine group ( TG ) . Each subject received a home sphygmomanometer with memory . The TG recorded and entered BP at least weekly . During office visits , the BP meters were downloaded and recorded BP compared to BP values transmitted via telemedicine . The telemedicine ( T ) BP values were similar to the meter recorded ( R ) values ( T : systolic/diastolic BP 133.4 + /- 11.1/77.5 + /- 6.8 mm Hg , and R : systolic/diastolic BP 136.4 + /- 11.9.4/79.7 + /- 7.5 mm Hg ) . The percent error was < 1 % for both systolic ( -0.02 + /- 0.04 % ) and diastolic ( -0.03 + /- 0.04 % ) BP . Lastly , the telemedicine BP values were similar to the office ( O ) BP values for systolic and diastolic BP ( T : systolic/diastolic BP 133.4 + /- 11.1/77.5 + /- 6.8 mm Hg , and O : systolic/diastolic BP 136.3 + /- 20.5/78.1 + /- 10.5 mm Hg ) . In underserved population s , this inexpensive approach of patients using a home monitor and entering these values into a telemedicine system provided accurate BP data The purpose of this study was to determine if ambulatory blood pressure measurement predicted total and cardiovascular mortality over and beyond clinic blood pressure measurement and other cardiovascular risk factors ; 5292 untreated hypertensive patients referred to a single blood pressure clinic who had clinic and ambulatory blood pressure measurement at baseline were followed up in a prospect i ve study of mortality outcome . Multiple Cox regression was used to model time to total and cause-specific mortality for ambulatory blood pressure measurement while adjusting for clinic blood pressure measurement and other risk factors at baseline . There were 646 deaths ( of which 389 were cardiovascular ) during a median follow-up period of 8.4 years . With adjustment for gender , age , risk indices , and clinic blood pressure , higher mean values of ambulatory blood pressure were independent predictors for cardiovascular mortality . The relative hazard ratio for each 10-mm Hg increase in systolic blood pressure was 1.12 ( 1.06 to 1.18 ; P<0.001 ) for daytime and 1.21 ( 1.15 to 1.27 ; P<0.001 ) for nighttime systolic blood pressure . The hazard ratios for each 5-mm Hg increase in diastolic blood pressure were 1.02 ( 0.99 to 1.07 ; P = NS ) for daytime and 1.09 ( 1.04 to 1.13 ; P<0.01 ) for nighttime diastolic pressures . The hazard ratios for nighttime ambulatory blood pressure remained significant after adjustment for daytime ambulatory blood pressure . These results have 2 important clinical messages : ambulatory measurement of blood pressure is superior to clinic measurement in predicting cardiovascular mortality , and nighttime blood pressure is the most potent predictor of outcome Aim . To compare the effectiveness of antihypertensive treatment based on telemonitoring of home blood pressure ( BP ) and conventional monitoring of office BP . Methods . Hypertensive patients ( n = 236 ) participated in a r and omized , controlled study . In the intervention group , antihypertensive treatment was based on home BP monitoring . BP readings were registered by a PDA and automatically transmitted to a server , by which the patient and doctor could communicate . In the control group , patients received usual care with office visits to adjust antihypertensive treatment as needed . Primary outcome was difference in systolic daytime ambulatory BP monitoring ( ABPM ) change between baseline and 6 months . Results . In both groups , systolic daytime ABPM decreased significantly from baseline to follow‐up . The decrease in systolic daytime ABPM was −11.9 mmHg in the intervention group and −9.6 mmHg in the control group ( mean difference −2.3 [ 95 % CI −6.1 to −1.5 ] , p = 0.225 ) . The likelihood of daytime ABPM normalization was similar in the two groups [ 32/113 ( 28 % ) vs 46/123 ( 37 % ) , p = 0.139 ] . Conclusion . Antihypertensive treatment based on telemonitoring of home BP was as effective as usual monitoring of office BP with regards to reduction of BP . Trial registration : Clinical Trials.gov identifier : NCT00282334 BACKGROUND Control of blood pressure is a key component of cardiovascular disease prevention , but is difficult to achieve and until recently has been the sole preserve of health professionals . This study assessed whether self-management by people with poorly controlled hypertension result ed in better blood pressure control compared with usual care . METHODS This r and omised controlled trial was undertaken in 24 general practice s in the UK . Patients aged 35 - 85 years were eligible for enrolment if they had blood pressure more than 140/90 mm Hg despite antihypertensive treatment and were willing to self-manage their hypertension . Participants were r and omly assigned in a 1:1 ratio to self-management , consisting of self-monitoring of blood pressure and self-titration of antihypertensive drugs , combined with telemonitoring of home blood pressure measurements or to usual care . R and omisation was done by use of a central web-based system and was stratified by general practice with minimisation for sex , baseline systolic blood pressure , and presence or absence of diabetes or chronic kidney disease . Neither participants nor investigators were masked to group assignment . The primary endpoint was change in mean systolic blood pressure between baseline and each follow-up point ( 6 months and 12 months ) . All r and omised patients who attended follow-up visits at 6 months and 12 months and had complete data for the primary outcome were included in the analysis , without imputation for missing data . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N17585681 . FINDINGS 527 participants were r and omly assigned to self-management ( n=263 ) or control ( n=264 ) , of whom 480 ( 91 % ; self-management , n=234 ; control , n=246 ) were included in the primary analysis . Mean systolic blood pressure decreased by 12.9 mm Hg ( 95 % CI 10.4 - 15.5 ) from baseline to 6 months in the self-management group and by 9.2 mm Hg ( 6.7 - 11.8 ) in the control group ( difference between groups 3.7 mm Hg , 0.8 - 6.6 ; p=0.013 ) . From baseline to 12 months , systolic blood pressure decreased by 17.6 mm Hg ( 14.9 - 20.3 ) in the self-management group and by 12.2 mm Hg ( 9.5 - 14.9 ) in the control group ( difference between groups 5.4 mm Hg , 2.4 - 8.5 ; p=0.0004 ) . Frequency of most side-effects did not differ between groups , apart from leg swelling ( self-management , 74 patients [ 32 % ] ; control , 55 patients [ 22 % ] ; p=0.022 ) . INTERPRETATION Self-management of hypertension in combination with telemonitoring of  blood pressure measurements represents an important new addition to control of hypertension in primary care . FUNDING Department of Health Policy Research Programme , National Coordinating Centre for Research Capacity Development , and Midl and s Research Practice s Consortium PURPOSE The present study evaluated whether an intervention using a short message service ( SMS ) by cellular phone and Internet would improve blood pressure , weight control , and serum lipids of obese patients with hypertension during 8 weeks . METHODS This is a quasi-experimental design with pre- and follow-up tests . Participants were recruited from the family medicine outpatient department of tertiary care hospital located in an urban city of South Korea . Twenty-eight patients were assigned to an intervention group and 21 to a control group . The goal of intervention was to bring blood pressure , body weight , and serum lipids levels close to normal ranges . Patients in the intervention group were requested to record their blood pressure and body weight in a weekly web based diary through the Internet or by cellular phones . The research ers sent optimal recommendations as an intervention to each patient , by both cellular phone and Internet weekly . The intervention was applied for 8 weeks . RESULTS Systolic ( SBP ) and diastolic blood pressures ( DBP ) significantly decreased by 9.1 and 7.2 mmHg respectively at 8 weeks from the baseline in the intervention group ( p<0.05 ) . However , after 8 weeks from the baseline both SBP and DBP in the control group had not changed significantly . Yet , There were significant mean decreases in body weight and waist circumference by 1.6 kg ( p<0.05 ) and 2.8 cm ( p<0.05 ) in the intervention group , respectively . In the control group increases in body weight and waist circumference ( p<0.05 ) mean changes were also significant . High density lipoprotein cholesterol ( HDL-C ) significantly increased , with a mean change of 3.7 mg/dl at 8 weeks from baseline in the intervention group ( p<0.05 ) . The mean change of HDL-C in the control group was , however , not significant . CONCLUSION During 8 weeks using this web-based intervention by way of cellular phone and Internet SMS improved blood pressure , body weight , waist circumference , and HDL-C in patients with obese hypertension This study was aim ed at assessing the diagnostic accuracy of telemedicine among hypertensive patients . This was a cross-sectional analysis of patients attending a hypertension clinic over a year-long study . Patients were seen both by telemedicine and in-person on the same day with order of the encounters r and omly determined . A telemedicine system , which utilized phone lines , was employed . For each type of encounter , whether telemedicine ( TM ) or in-person ( IP ) , clinical data on blood pressure ( BP ) control as well as physician ordering patterns were collected . Receiver Operator Characteristic ( ROC ) curves were used to assess the validity of TM as compared to IP in the assessment of uncontrolled hypertension .  Sixty-two patients participated result ing in 107-paired visits over the year-long study period . The mean age of the 62 participants was 67.1 + /- 11.4 years ; 56.6 % were men . ROC curves for detecting elevated mean blood pressure provided an area under the curve ( 
    Output:
    