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 —Hypertension is a leading mortality risk factor yet inadequately controlled in most affected subjects . Effective programs to address this problem are lacking . We hypothesized that an information technology – supported management program could help improve blood pressure ( BP ) control . Methods and Results —This r and omized controlled trial included 223 primary care hypertensive subjects with mean 24-hour BP > 130/80 and daytime BP > 135/85 mm Hg measured with ambulatory monitoring ( ABPM ) . Intervention subjects received a BP monitor and access to an information technology – supported adherence and BP monitoring system providing nurses , pharmacists , and physicians with monthly reports . Control subjects received usual care . The mean ( ±SD ) follow-up was 348 ( ±78 ) and 349 ( ±84 ) days in the intervention and control group , respectively . The primary end point of the change in the mean 24-hour ambulatory BP was consistently greater in intervention subjects for both systolic ( −11.9 versus −7.1 mm Hg ; P<0.001 ) and diastolic BP ( −6.6 versus −4.5 mm Hg ; P=0.007 ) . The proportion of subjects that achieved Canadian Guideline target BP ( 46.0 % versus 28.6 % ) was also greater in the intervention group ( P=0.006 ) . We observed similar BP declines for ABPM and self-recorded home BP suggesting the latter could be an alternative for confirming BP control . The intervention was associated with more physician-driven antihypertensive dose adjustments or changes in agents ( P=0.03 ) , more antihypertensive classes at study end ( P=0.007 ) , and a trend toward improved adherence measured by prescription refills ( P=0.07 ) . Conclusions —This multidisciplinary information technology – supported program that provided feedback to patients and healthcare providers significantly improved blood pressure levels in a primary care setting Background Lifestyle modification is recommended for management of prehypertension , yet finding effective interventions to reach rural women is a public health challenge . This community-based clinical trial compared the effectiveness of st and ard advice to two multi-component theory-based tailored interventions , using web-based or print-mailed delivery , in reducing blood pressure among rural women , ages 40–69 , with prehypertension . Methods 289 women with prehypertension enrolled in the Wellness for Women : DASHing towards Health trial , a 12-month intervention with 12-month follow-up . Women were r and omly assigned to groups using a 1:2:2 ratio , comparing st and ard advice ( 30-minute counseling session ) to two interventions ( two 2-hour counseling sessions , 5 phone goal - setting sessions , strength-training video , and 16 tailored newsletters , web-based or print-mailed ) . Linear mixed model methods were used to test planned pairwise comparisons of marginal mean change in blood pressure , healthy eating and activity , adjusted for age and baseline level . General estimating equations were used to examine the proportion of women achieving normotensive status and meeting health outcome criteria for eating and activity . Results Mean blood pressure reduction ranged from 3.8 ( SD = 9.8 ) mm Hg to 8.1 ( SD = 10.4 ) mm Hg . The 24-month estimated marginal proportions of women achieving normotensive status were 47 % for web-based , and 39 % for both print-mailed and st and ard advice groups , with no group differences ( p = .11 and p = .09 , respectively ) . Web-based and print-mailed groups improved more than st and ard advice group for waist circumference ( p = .017 and p = .016 , respectively ) ; % daily calories from fat ( p = .018 and p = .030 ) and saturated fat ( p = .049 and p = .013 ) ; daily servings of fruit and vegetables ( p = .008 and p < .005 ) ; and low fat dairy ( p < .001 and p = .002 ) . Greater improvements were observed in web-based versus st and ard advice groups in systolic blood pressure ( p = .048 ) and estimated VO2max ( p = .037 ) . Dropout rates were 6 % by 6-months , 11.4 % by 24 months , with no differences across groups . Conclusions Rural women with prehypertension receiving  distance-delivery theory-based lifestyle modifications can achieve a reduction of blood pressure and attainment of normotensive status . Trial registration Clinical Trials.gov Lowering blood pressure reduces cardiovascular risk , yet hypertension is poorly controlled in diabetic patients . In a pilot study we demonstrated that a home blood pressure telemonitoring system , which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading , improved blood pressure control . Messages were based on care paths defined by running averages of transmitted readings . The present study tests the system 's effectiveness in a r and omized , controlled trial in diabetic patients with uncontrolled systolic hypertension . Of 244 subjects screened for eligibility , 110 ( 45 % ) were r and omly allocated to the intervention ( n=55 ) or control ( n=55 ) group , and 105 ( 95.5 % ) completed the 1-year outcome visit . In the intention-to-treat analysis , mean daytime ambulatory systolic blood pressure , the primary end point , decreased significantly only in the intervention group by 9.1±15.6 mmHg ( SD ; P<0.0001 ) , and the mean between-group difference was 7.1±2.3 mmHg ( SE ; P<0.005 ) . Furthermore , 51 % of intervention subjects achieved the guideline recommended target of < 130/80 mmHg compared with 31 % of control subjects ( P<0.05 ) . These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians . Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale ( baseline , 4.1±3.76 ; exit , 5.2±4.30 ; P=0.014 ) . This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension  and improved hypertension control . Home blood pressure monitoring alone had no effect on blood pressure . Promoting patient self-care may have negative psychological effects OBJECTIVE To assess the effects of web-based care management on glucose and blood pressure control over 12 months in patients with poorly controlled diabetes . RESEARCH DESIGN AND METHODS For this study , 104 patients with diabetes and HbA(1c ) ( A1C ) > or = 9.0 % who received their care at a Department of Veterans Affairs medical center were recruited . All participants completed a  diabetes education class  and were r and omized to continue with their usual care ( n = 52 ) or receive web-based care management ( n = 52 ) . The web-based group received a notebook computer , glucose and blood pressure monitoring devices , and access to a care management website . The website provided educational modules , accepted uploads from monitoring devices , and had an internal messaging system for patients to communicate with the care manager . RESULTS Participants receiving web-based care management had lower A1C over 12 months ( P < 0.05 ) when compared with education and usual care . Persistent website users had greater improvement in A1C when compared with intermittent users ( -1.9 vs. -1.2 % ; P = 0.051 ) or education and usual care ( -1.4 % ; P < 0.05 ) . A larger number of website data uploads was associated with a larger decline in A1C ( highest tertile -2.1 % , lowest tertile -1.0 % ; P < 0.02 ) . Hypertensive participants in the web-based group had a greater reduction in systolic blood pressure ( P < 0.01 ) . HDL cholesterol rose and triglycerides fell in the web-based group ( P < 0.05 ) . CONCLUSIONS Web-based care management may be a useful adjunct in the care of patients with poorly controlled diabetes OBJECTIVE : To determine if home-centered monitoring through telemedicine has an impact on clinical characteristics , metabolic profile and quality of life in overweight and obese patients . DESIGN : R and omized controlled trial , 6-month duration . SETTING : Tertiary care academic hospital . SUBJECTS : A total of 122 patients were eligible to participate as they met the inclusion criteria of increased body mass index ( BMI > 25 kg/m2 ) , age>18 and < 70 y and ability to operate electronic microdevices . INTERVENTIONS : All patients in the control group ( n=77 ) received st and ard hospital care .  Patients in the intervention group ( n=45 ) , additionally , measured three times a week , for 6 months , their blood pressure and body weight and transmitted them to an automated call center . These values were not shared with the patients ’ physician or dietician . MAIN OUTCOME MEASURES : Clinical ( body weight , BMI , blood pressure ) , laboratory ( fasting plasma glucose , triglycerides , HDL-cholesterol , total cholesterol ) and quality of life parameters ( SF-36 ® , Visual Analog Scale of European Quality -5 Dimensions , Obesity Assessment Survey ) . Data were analyzed in an intention-to-treat-way ( last observation carried forward ) . RESULTS : Drop-out rate was similar in the control and intervention groups : 12 vs 11 percent , respectively , P = NS . There were no significant differences at baseline between intervention and control groups in all main outcome parameters . There were significant decreases for patients in the intervention group in body weight ( from 101.6±22.4 to 89.2±14.7 kg , P=0.002 , P=0.05 vs controls at 6 months ) , total cholesterol ( from 247.6±42.0 to 220.7±42.6 mg/dl , P=0.002 , P=0.05 vs controls at 6 months ) and triglycerides ( from 148.4±35.0 to 122.3±31.4 mg/dl , P=0.001 , P=0.01 vs controls at 6 months ) . Intervention group patients made a total of 1997 phone contacts . The number of phone contacts was correlated positively with Social Functioning ( SF ) , Vitality ( VT ) and Mental Health ( MH ) scores of SF-36 ® at baseline ( r=0.48 , r=0.41 , r=0.41 , respectively , P=0.05 ) but not with weight loss . CONCLUSIONS : Home-centered , intense treatment through the use of telemedicine can be effective in improving short-term obesity outcomes Background Blood pressure ( BP ) control remains elusive for many Americans . Although home health nurses are uniquely positioned to help vulnerable individuals achieve BP control , hypertension ( HTN ) management has not been a high priority in post-acute care . Objective To examine the effects of two home-based interventions design ed to improve BP outcomes among high-risk African-American patients . Design Cluster r and omized controlled trial . Participants A total of 845 newly admitted patients with uncontrolled HTN ( JNC7 stages 1 or 2 ) . Interventions The “ basic ” intervention delivered key HTN information to clinicians and patients , and a home BP monitor to patients , while the patients received usual post-acute care . The “ augmented ” intervention provided more intensive and extensive HTN information , monitoring and feedback for 3 months beyond the index home care admission . Measures Primary : BP control . Secondary : reductions in mmHG SBP and DBP , improvements in proportions improving JNC7 stage or achieving clinical ly meaningful reductions in SBP and DBP . Methods Multivariate regression models . Key Results The basic intervention produced no significant BP improvements ; the augmented intervention significantly improved stage 2 patients ’ outcomes . Among stage 2 patients , the augmented intervention increased BP control by 8.7 percentage points relative to usual care ( 8.9 % vs. 17.6 % ; p = 0.01 ) , yielded an 8.3 mmHG relative reduction in SBP ( p = 0.01 ) , and increased the proportion achieving at least a 20 mmHG reduction in SBP by 16.4 percentage points ( p = 0.01 ) . Conclusion Among stage 2 patients , a nurse-led intervention providing additional HTN medication review and patient self-management support during the 3-month post-acute care period yielded significant improvements in 3-month BP control , plus improvements in secondary BP outcomes BACKGROUND Web-based interventions for weight control could promote more-widespread dissemination of weight-loss opportunities ; however , they remain limited in effectiveness . Incorporating weight-control practice s used by individuals with long-term weight-loss success ( " positive deviants " ) may improve the efficacy of web-based weight control interventions . PURPOSE To evaluate the efficacy of AchieveTogether , a web-based weight-loss intervention for adults based on user-generated weight-loss strategies from successful weight losers . DESIGN In 2009 - 2010 , participants were r and omized to either a 12-week  web-based intervention , AchieveTogether , or a wait-list control condition . SETTING / PARTICIPANTS 100 overweight or obese adults participated in the study . INTERVENTION AchieveTogether was design ed to help individuals implement weight control practice s used by others who successfully lost and maintained weight . MAIN OUTCOME MEASURES The primary outcome was change in weight . Secondary outcomes included blood pressure , 
    Output:
    
agent
For those surrogate outcomes , low-strength evidence failed to show difference .
In subgroup analysis , high strength evidence supported a lower BP with HBPT that lasted for 6 or 12 months and was accompanied with counselling support from study personnel .
HBPT can improve BP control in the hypertensive patients .
It may be more efficacious when a proactive additional support is provided during the intervention process
***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 —Hypertension is a leading mortality risk factor yet inadequately controlled in most affected subjects . Effective programs to address this problem are lacking . We hypothesized that an information technology – supported management program could help improve blood pressure ( BP ) control . Methods and Results —This r and omized controlled trial included 223 primary care hypertensive subjects with mean 24-hour BP > 130/80 and daytime BP > 135/85 mm Hg measured with ambulatory monitoring ( ABPM ) . Intervention subjects received a BP monitor and access to an information technology – supported adherence and BP monitoring system providing nurses , pharmacists , and physicians with monthly reports . Control subjects received usual care . The mean ( ±SD ) follow-up was 348 ( ±78 ) and 349 ( ±84 ) days in the intervention and control group , respectively . The primary end point of the change in the mean 24-hour ambulatory BP was consistently greater in intervention subjects for both systolic ( −11.9 versus −7.1 mm Hg ; P<0.001 ) and diastolic BP ( −6.6 versus −4.5 mm Hg ; P=0.007 ) . The proportion of subjects that achieved Canadian Guideline target BP ( 46.0 % versus 28.6 % ) was also greater in the intervention group ( P=0.006 ) . We observed similar BP declines for ABPM and self-recorded home BP suggesting the latter could be an alternative for confirming BP control . The intervention was associated with more physician-driven antihypertensive dose adjustments or changes in agents ( P=0.03 ) , more antihypertensive classes at study end ( P=0.007 ) , and a trend toward improved adherence measured by prescription refills ( P=0.07 ) . Conclusions —This multidisciplinary information technology – supported program that provided feedback to patients and healthcare providers significantly improved blood pressure levels in a primary care setting Background Lifestyle modification is recommended for management of prehypertension , yet finding effective interventions to reach rural women is a public health challenge . This community-based clinical trial compared the effectiveness of st and ard advice to two multi-component theory-based tailored interventions , using web-based or print-mailed delivery , in reducing blood pressure among rural women , ages 40–69 , with prehypertension . Methods 289 women with prehypertension enrolled in the Wellness for Women : DASHing towards Health trial , a 12-month intervention with 12-month follow-up . Women were r and omly assigned to groups using a 1:2:2 ratio , comparing st and ard advice ( 30-minute counseling session ) to two interventions ( two 2-hour counseling sessions , 5 phone goal - setting sessions , strength-training video , and 16 tailored newsletters , web-based or print-mailed ) . Linear mixed model methods were used to test planned pairwise comparisons of marginal mean change in blood pressure , healthy eating and activity , adjusted for age and baseline level . General estimating equations were used to examine the proportion of women achieving normotensive status and meeting health outcome criteria for eating and activity . Results Mean blood pressure reduction ranged from 3.8 ( SD = 9.8 ) mm Hg to 8.1 ( SD = 10.4 ) mm Hg . The 24-month estimated marginal proportions of women achieving normotensive status were 47 % for web-based , and 39 % for both print-mailed and st and ard advice groups , with no group differences ( p = .11 and p = .09 , respectively ) . Web-based and print-mailed groups improved more than st and ard advice group for waist circumference ( p = .017 and p = .016 , respectively ) ; % daily calories from fat ( p = .018 and p = .030 ) and saturated fat ( p = .049 and p = .013 ) ; daily servings of fruit and vegetables ( p = .008 and p < .005 ) ; and low fat dairy ( p < .001 and p = .002 ) . Greater improvements were observed in web-based versus st and ard advice groups in systolic blood pressure ( p = .048 ) and estimated VO2max ( p = .037 ) . Dropout rates were 6 % by 6-months , 11.4 % by 24 months , with no differences across groups . Conclusions Rural women with prehypertension receiving  distance-delivery theory-based lifestyle modifications can achieve a reduction of blood pressure and attainment of normotensive status . Trial registration Clinical Trials.gov Lowering blood pressure reduces cardiovascular risk , yet hypertension is poorly controlled in diabetic patients . In a pilot study we demonstrated that a home blood pressure telemonitoring system , which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading , improved blood pressure control . Messages were based on care paths defined by running averages of transmitted readings . The present study tests the system 's effectiveness in a r and omized , controlled trial in diabetic patients with uncontrolled systolic hypertension . Of 244 subjects screened for eligibility , 110 ( 45 % ) were r and omly allocated to the intervention ( n=55 ) or control ( n=55 ) group , and 105 ( 95.5 % ) completed the 1-year outcome visit . In the intention-to-treat analysis , mean daytime ambulatory systolic blood pressure , the primary end point , decreased significantly only in the intervention group by 9.1±15.6 mmHg ( SD ; P<0.0001 ) , and the mean between-group difference was 7.1±2.3 mmHg ( SE ; P<0.005 ) . Furthermore , 51 % of intervention subjects achieved the guideline recommended target of < 130/80 mmHg compared with 31 % of control subjects ( P<0.05 ) . These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians . Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale ( baseline , 4.1±3.76 ; exit , 5.2±4.30 ; P=0.014 ) . This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension  and improved hypertension control . Home blood pressure monitoring alone had no effect on blood pressure . Promoting patient self-care may have negative psychological effects OBJECTIVE To assess the effects of web-based care management on glucose and blood pressure control over 12 months in patients with poorly controlled diabetes . RESEARCH DESIGN AND METHODS For this study , 104 patients with diabetes and HbA(1c ) ( A1C ) > or = 9.0 % who received their care at a Department of Veterans Affairs medical center were recruited . All participants completed a  diabetes education class  and were r and omized to continue with their usual care ( n = 52 ) or receive web-based care management ( n = 52 ) . The web-based group received a notebook computer , glucose and blood pressure monitoring devices , and access to a care management website . The website provided educational modules , accepted uploads from monitoring devices , and had an internal messaging system for patients to communicate with the care manager . RESULTS Participants receiving web-based care management had lower A1C over 12 months ( P < 0.05 ) when compared with education and usual care . Persistent website users had greater improvement in A1C when compared with intermittent users ( -1.9 vs. -1.2 % ; P = 0.051 ) or education and usual care ( -1.4 % ; P < 0.05 ) . A larger number of website data uploads was associated with a larger decline in A1C ( highest tertile -2.1 % , lowest tertile -1.0 % ; P < 0.02 ) . Hypertensive participants in the web-based group had a greater reduction in systolic blood pressure ( P < 0.01 ) . HDL cholesterol rose and triglycerides fell in the web-based group ( P < 0.05 ) . CONCLUSIONS Web-based care management may be a useful adjunct in the care of patients with poorly controlled diabetes OBJECTIVE : To determine if home-centered monitoring through telemedicine has an impact on clinical characteristics , metabolic profile and quality of life in overweight and obese patients . DESIGN : R and omized controlled trial , 6-month duration . SETTING : Tertiary care academic hospital . SUBJECTS : A total of 122 patients were eligible to participate as they met the inclusion criteria of increased body mass index ( BMI > 25 kg/m2 ) , age>18 and < 70 y and ability to operate electronic microdevices . INTERVENTIONS : All patients in the control group ( n=77 ) received st and ard hospital care .  Patients in the intervention group ( n=45 ) , additionally , measured three times a week , for 6 months , their blood pressure and body weight and transmitted them to an automated call center . These values were not shared with the patients ’ physician or dietician . MAIN OUTCOME MEASURES : Clinical ( body weight , BMI , blood pressure ) , laboratory ( fasting plasma glucose , triglycerides , HDL-cholesterol , total cholesterol ) and quality of life parameters ( SF-36 ® , Visual Analog Scale of European Quality -5 Dimensions , Obesity Assessment Survey ) . Data were analyzed in an intention-to-treat-way ( last observation carried forward ) . RESULTS : Drop-out rate was similar in the control and intervention groups : 12 vs 11 percent , respectively , P = NS . There were no significant differences at baseline between intervention and control groups in all main outcome parameters . There were significant decreases for patients in the intervention group in body weight ( from 101.6±22.4 to 89.2±14.7 kg , P=0.002 , P=0.05 vs controls at 6 months ) , total cholesterol ( from 247.6±42.0 to 220.7±42.6 mg/dl , P=0.002 , P=0.05 vs controls at 6 months ) and triglycerides ( from 148.4±35.0 to 122.3±31.4 mg/dl , P=0.001 , P=0.01 vs controls at 6 months ) . Intervention group patients made a total of 1997 phone contacts . The number of phone contacts was correlated positively with Social Functioning ( SF ) , Vitality ( VT ) and Mental Health ( MH ) scores of SF-36 ® at baseline ( r=0.48 , r=0.41 , r=0.41 , respectively , P=0.05 ) but not with weight loss . CONCLUSIONS : Home-centered , intense treatment through the use of telemedicine can be effective in improving short-term obesity outcomes Background Blood pressure ( BP ) control remains elusive for many Americans . Although home health nurses are uniquely positioned to help vulnerable individuals achieve BP control , hypertension ( HTN ) management has not been a high priority in post-acute care . Objective To examine the effects of two home-based interventions design ed to improve BP outcomes among high-risk African-American patients . Design Cluster r and omized controlled trial . Participants A total of 845 newly admitted patients with uncontrolled HTN ( JNC7 stages 1 or 2 ) . Interventions The “ basic ” intervention delivered key HTN information to clinicians and patients , and a home BP monitor to patients , while the patients received usual post-acute care . The “ augmented ” intervention provided more intensive and extensive HTN information , monitoring and feedback for 3 months beyond the index home care admission . Measures Primary : BP control . Secondary : reductions in mmHG SBP and DBP , improvements in proportions improving JNC7 stage or achieving clinical ly meaningful reductions in SBP and DBP . Methods Multivariate regression models . Key Results The basic intervention produced no significant BP improvements ; the augmented intervention significantly improved stage 2 patients ’ outcomes . Among stage 2 patients , the augmented intervention increased BP control by 8.7 percentage points relative to usual care ( 8.9 % vs. 17.6 % ; p = 0.01 ) , yielded an 8.3 mmHG relative reduction in SBP ( p = 0.01 ) , and increased the proportion achieving at least a 20 mmHG reduction in SBP by 16.4 percentage points ( p = 0.01 ) . Conclusion Among stage 2 patients , a nurse-led intervention providing additional HTN medication review and patient self-management support during the 3-month post-acute care period yielded significant improvements in 3-month BP control , plus improvements in secondary BP outcomes BACKGROUND Web-based interventions for weight control could promote more-widespread dissemination of weight-loss opportunities ; however , they remain limited in effectiveness . Incorporating weight-control practice s used by individuals with long-term weight-loss success ( " positive deviants " ) may improve the efficacy of web-based weight control interventions . PURPOSE To evaluate the efficacy of AchieveTogether , a web-based weight-loss intervention for adults based on user-generated weight-loss strategies from successful weight losers . DESIGN In 2009 - 2010 , participants were r and omized to either a 12-week  web-based intervention , AchieveTogether , or a wait-list control condition . SETTING / PARTICIPANTS 100 overweight or obese adults participated in the study . INTERVENTION AchieveTogether was design ed to help individuals implement weight control practice s used by others who successfully lost and maintained weight . MAIN OUTCOME MEASURES The primary outcome was change in weight . Secondary outcomes included blood pressure , 
    Output:
    