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: Summary : Twelve white men with essential hypertension were treated for 1 month in r and omized order with either placebo or low-dose furosemide ( 40 mg/day ) and compared to 22 race , age- , and diet-matched normal controls .  Furosemide therapy significantly reduced mean arterial pressure ( 108.6 ± 2.4 vs. 101.0 ± 2.7 mm Hg . p < 0.02 ) in association with a significant increase in 24 hr urinary kallikrein activity ( 7.9 ± 1.8 vs. 13.4 ± 2.8 esterase units/24 hr . p < 0.02 ) . Normal controls on no therapy excreted 19.4 ± 2.6 esterase units/24hr of urinary kallikrein activity , significantly greater than hypertensives on placebo ( p < 0.01 ) but not hypertensives on furosemide ( p < 0.01 ) . The decrease in mean arterial pressure and the increase in urinary kallikrein activity induced by furosemide were not associated with a demonstrable change in renal hemodynamics . plasma renin activity , or plasma aldosterone concentration , but they were associated with a significant increase in intravascular volume ( 5.876 ± 339 vs. 6.808 ± 346 ml . p < 0.01 ) . A significant ( p < 0.05 ) inverse correlation between mean arterial pressure and urinary kallikrein activity suggests a possible role for the kallikrein-kinin system in the antihypertensive mechanism of furosemide In a double‐blind study , 28 patients having mild to moderate essential hypertension were r and omly assigned to a 6‐week regimen of ticrynafen , hydrochlorothiazide , or placebo .  Blood pressure fell after ticrynafen and hydrochlorothiazide .  Serum uric acid fell strikingly with ticrynafen whereas it rose with hydrochlorothiazide .  Serum potassium declined very little with ticrynafen ; much less than with hydrochlorothiazide . Serum creatinine and blood urea nitrogen rose slightly more with ticrynafen than with hydrochlorothiazide . There were no clinical adverse effects to either of the medications . Ticrynafen appears to be an effective antihypertensive with a substantial hypouricemic effect Loop diuretics , such as torasemide and furosemide , are important agents in the treatment of chronic heart failure . Beneficial effects of torasemide immediate-release formulation beyond diuresis have been documented as the ability of this compound to inhibit myocardial synthesis and deposition of collagen type I in patients with chronic heart failure . In addition , torasemide-treated patients , but not furosemide-treated patients , showed decreased serum concentrations of the C-terminal propeptide of procollagen type I , a biochemical marker of myocardial fibrosis . The aim of the TORAFIC study is to test the efficacy of torasemide prolonged-release formulation ( PR ) in reducing myocardial fibrosis in chronic heart failure in a large , r and omized clinical trial . Methods : This prospect i ve , Phase IV , r and omized , blinded end point , active-controlled clinical trial will r and omize 142 patients with chronic heart failure in New York Heart Association functional class II – IV to 8 months treatment with either torasemide-PR ( 10–40 mg daily ) or furosemide ( 40–160 mg daily ) . The primary objective is to test the hypothesis that torasemide-PR is superior to furosemide in reducing myocardial fibrosis . The primary outcome measure is the difference in the change of serum propeptide of procollagen type I concentration from the initial to the final visit between both study groups . Secondary outcome measures include all efficacy variables related to heart failure ( signs and symptoms , ECG , echocardiogram and serum levels of N-terminal brain natriuretic propeptide ) . Secondary safety variables are heart rate , blood pressure , laboratory data , adverse events , cardiovascular events ( hospital admission , emergency department visits ) and quality of life ( Minnesota question naire ) . Discussion : This trial will test whether torasemide-PR possesses antifibrotic properties , which may provide an additional benefit beyond diuresis in patients with chronic heart failure The antihypertensive efficacy and tolerability of a fixed-dose combination containing 40 mg penbutolol ( a beta-blocking agent ) and 6 mg piretanide ( a diuretic ) in comparison to placebo was investigated in a double-blind , crossover study in 20 patients with mild to moderate essential hypertension . After a 1-week period on placebo , patients were allocated at r and om to receive 1 tablet daily for 4 weeks of either the combination preparation or placebo and were then crossed over to the alternative medication for a further 4 weeks . The reduction in systolic and diastolic blood pressure both at rest , during maximal ergometric exercise and isometric word load , and also in the diurnal blood pressure profile over 24 hours was significantly greater in the group treated with the fixed-dose combination than in the placebo group . Pulse rate was also decreased to a greater extent . Mean diastolic blood pressure before exercise was reduced to normal ( 85.5 mmHg ) after 4-weeks ' treatment with the fixed-dose combination . Biochemical , haematological and urinary parameters showed no clinical ly relevant changes after either treatment . One patient complained of transient dizziness during treatment with the fixed-dose combination . No patient withdrew prematurely from the study because of side-effects Eighteen patients whose clinic blood pressure ( BP ) remained over 95 mmHg despite treatment with captopril 50 mg twice daily plus frusemide 40 mg twice daily were r and omised in a crossover study to four weeks ' treatment with once daily atenolol 100 mg , slow release propranolol 160 mg or placebo . The reduction in BP on atenolol was superior to that on both propranolol and placebo . The mean supine BP 24 hours post dosing were 177/110 mmHg ( placebo ) , 173/109 mmHg ( propranolol ) and 164/100 mmHg ( atenolol ) . The corresponding mean heart rates were 77 bpm ( placebo ) , 63 bpm ( propranolol ) and 62 bpm ( propranolol ) and 62 bpm ( atenolol ) . The difference in hypotensive efficacy between atenolol and propranolol is not readily explained but our study shows that atenolol has a clinical ly useful supplementary effect on BP . Refractory hypertension remains an important clinical problem and further studies are required to establish the optimum combination of drugs that should be used with captopril in order to achieve ' target ' BP in patients with moderate to severe hypertension BACKGROUND Contrast nephropathy ( CN ) is a common cause of renal dysfunction that may be prevented by saline hydration and by drugs such as theophylline or furosemide . Whether oral saline hydration is as efficient as intravenous saline hydration is unknown . The preventive efficacy of theophylline and furosemide for CN remains controversial . The purpose of the current study was to evaluate the efficacy of oral saline hydration and of intravenous saline hydration plus theophylline or furosemide for the prevention of CN . METHODS We prospect ively studied 312 patients with chronic renal failure ( serum creatinine 201+/-81 micromol/l , Cockcroft clearance 37+/-12 ml/min/1.73 m(2 ) ) , who were undergoing various radiological procedures with a non-ionic , low osmolality contrast agent . Patients were r and omly assigned to four arms . In arm A , patients received 1 g/10 kg of body weight/day of sodium chloride per os for 2 days before the procedure . In arm B , patients received 0.9 % saline intravenously at a rate of 15 ml/kg for 6 h before the procedure . In arm C , patients received the same saline hydration as in arm B plus 5 mg/kg theophylline per os in one dose 1 h before the procedure . In arm D , patients received the same saline hydration as in arm B plus 3 mg/kg of furosemide intravenously just after the procedure . RESULTS Patients were well-matched with no significant differences at baseline in any measured parameters .  Acute renal failure , defined as an increase in serum creatinine of 44 micromol/l ( 0.5 mg/dl ) , occurred in 27 out of 312 patients ( 8.7 % ) . There was no significant difference between the rate of renal failure in the different arms of the study : five out of 76 ( 6.6 % ) in arm A , four out of 77 ( 5.2 % ) in arm B , six out of 80 ( 7.5 % ) in arm C and 12 out of 79 ( 15.2 % ) in arm D. No patient had fluid overload or a significant increase in blood pressure in the 2 days following the radiological procedure . The independent predictors of CN were diabetes mellitus , high baseline serum creatinine and high systolic blood pressure . CONCLUSIONS Oral saline hydration was as efficient as intravenous saline hydration for the prevention of CN in patients with stage 3 renal diseases . Furosemide and theophylline were not protective Diuretics are frequently required to treat fluid retention in patients with congestive heart failure ( CHF ) . Unfortunately , they can lead to a decline in renal function , electrolyte depletion , and neurohumoral activation . Arginine vasopressin ( AVP ) promotes renal water reabsorption via the V2 receptor , and its levels are increased in CHF . This study was design ed to assess the effects of a single oral dose of tolvaptan , a selective V2-receptor blocker , in the absence of other medications , on renal function in human CHF and to compare this to the effects of a single oral dose of furosemide . We hypothesized that V2-receptor antagonism would yield a diuresis comparable to furosemide but would not adversely affect renal hemodynamics , plasma electrolyte concentration , or neurohumoral activation in stable human CHF . Renal and neurohumoral effects of tolvaptan and furosemide were assessed in an open-label , r and omized , placebo-controlled crossover study in 14 patients with NYHA II-III CHF . Patients received placebo or 30 mg of tolvaptan on day 1 and were crossed over to the other medication on day 3 . On day 5 , all subjects received 80 mg of furosemide . Tolvaptan and furosemide induced similar diuretic responses . Unlike tolvaptan , furosemide increased urinary sodium and potassium excretion and decreased renal blood flow .  Tolvaptan , furosemide , and placebo did not differ with respect to mean arterial pressure , glomerular filtration rate , or serum sodium and potassium . We conclude that tolvaptan is an effective aquaretic with no adverse effects on renal hemodynamics or serum electrolytes in patients with mild to moderate heart failure The antihypertensive effect and tolerability of enalaprilat , an intravenously administered angiotensin converting enzyme inhibitor , was studied in 65 patients with moderate or severe hypertension . In this r and omized , double-blind study , enalaprilat was compared with placebo in 42 ( 22 enalaprilat , 20 placebo )  moderate hypertensive ( diastolic blood pressure [ BP ] 100 to 114 mm Hg ) patients . It was compared with furosemide in 23 ( 12 enalaprilat , 11 furosemide ) severe hypertensive ( diastolic BP 115 to 130 mm Hg ) patients . Enalaprilat ( 1.25 or 5.0 mg ) , placebo ( 5 % dextrose ) or furosemide ( 40 or 80 mg ) was given every 6 hours intravenously up to 48 hours . In the moderate hypertension stratum , the mean supine diastolic BP was significantly ( p less than or equal to 0.01 ) reduced from baseline at all timepoints in the enalaprilat group . These diastolic BP reductions were significantly ( p less than or equal to 0.01 ) greater in the enalaprilat group than the placebo at 1 to 24 hours ( -12 vs -4 mm Hg ) , with 59 % of the patients responding to enalaprilat compared with 30 % of the patients responding to placebo . An even greater reduction ( p less than or equal to 0.01 ) was seen at 25 to 48 hours ( -14 vs -7 mm Hg , with 73 % enalaprilat vs 58 % placebo responders ) . Significant ( p less than or equal to 0.01 ) reductions in mean , supine systolic BP were also seen at 1 to 24 hours ( -22 vs -2 mm Hg ) and 25 to 48 hours ( -24 vs -8 mm Hg ) during the 48 hours of the double-blind treatment phase in the enalaprilat group compared with placebo . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND In chronic kidney disease ( CKD ) , loop di 
    Output:
    
agent
We found no clinical ly meaningful blood pressure-lowering differences between different drugs within the loop diuretic class .
***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: Summary : Twelve white men with essential hypertension were treated for 1 month in r and omized order with either placebo or low-dose furosemide ( 40 mg/day ) and compared to 22 race , age- , and diet-matched normal controls .  Furosemide therapy significantly reduced mean arterial pressure ( 108.6 ± 2.4 vs. 101.0 ± 2.7 mm Hg . p < 0.02 ) in association with a significant increase in 24 hr urinary kallikrein activity ( 7.9 ± 1.8 vs. 13.4 ± 2.8 esterase units/24 hr . p < 0.02 ) . Normal controls on no therapy excreted 19.4 ± 2.6 esterase units/24hr of urinary kallikrein activity , significantly greater than hypertensives on placebo ( p < 0.01 ) but not hypertensives on furosemide ( p < 0.01 ) . The decrease in mean arterial pressure and the increase in urinary kallikrein activity induced by furosemide were not associated with a demonstrable change in renal hemodynamics . plasma renin activity , or plasma aldosterone concentration , but they were associated with a significant increase in intravascular volume ( 5.876 ± 339 vs. 6.808 ± 346 ml . p < 0.01 ) . A significant ( p < 0.05 ) inverse correlation between mean arterial pressure and urinary kallikrein activity suggests a possible role for the kallikrein-kinin system in the antihypertensive mechanism of furosemide In a double‐blind study , 28 patients having mild to moderate essential hypertension were r and omly assigned to a 6‐week regimen of ticrynafen , hydrochlorothiazide , or placebo .  Blood pressure fell after ticrynafen and hydrochlorothiazide .  Serum uric acid fell strikingly with ticrynafen whereas it rose with hydrochlorothiazide .  Serum potassium declined very little with ticrynafen ; much less than with hydrochlorothiazide . Serum creatinine and blood urea nitrogen rose slightly more with ticrynafen than with hydrochlorothiazide . There were no clinical adverse effects to either of the medications . Ticrynafen appears to be an effective antihypertensive with a substantial hypouricemic effect Loop diuretics , such as torasemide and furosemide , are important agents in the treatment of chronic heart failure . Beneficial effects of torasemide immediate-release formulation beyond diuresis have been documented as the ability of this compound to inhibit myocardial synthesis and deposition of collagen type I in patients with chronic heart failure . In addition , torasemide-treated patients , but not furosemide-treated patients , showed decreased serum concentrations of the C-terminal propeptide of procollagen type I , a biochemical marker of myocardial fibrosis . The aim of the TORAFIC study is to test the efficacy of torasemide prolonged-release formulation ( PR ) in reducing myocardial fibrosis in chronic heart failure in a large , r and omized clinical trial . Methods : This prospect i ve , Phase IV , r and omized , blinded end point , active-controlled clinical trial will r and omize 142 patients with chronic heart failure in New York Heart Association functional class II – IV to 8 months treatment with either torasemide-PR ( 10–40 mg daily ) or furosemide ( 40–160 mg daily ) . The primary objective is to test the hypothesis that torasemide-PR is superior to furosemide in reducing myocardial fibrosis . The primary outcome measure is the difference in the change of serum propeptide of procollagen type I concentration from the initial to the final visit between both study groups . Secondary outcome measures include all efficacy variables related to heart failure ( signs and symptoms , ECG , echocardiogram and serum levels of N-terminal brain natriuretic propeptide ) . Secondary safety variables are heart rate , blood pressure , laboratory data , adverse events , cardiovascular events ( hospital admission , emergency department visits ) and quality of life ( Minnesota question naire ) . Discussion : This trial will test whether torasemide-PR possesses antifibrotic properties , which may provide an additional benefit beyond diuresis in patients with chronic heart failure The antihypertensive efficacy and tolerability of a fixed-dose combination containing 40 mg penbutolol ( a beta-blocking agent ) and 6 mg piretanide ( a diuretic ) in comparison to placebo was investigated in a double-blind , crossover study in 20 patients with mild to moderate essential hypertension . After a 1-week period on placebo , patients were allocated at r and om to receive 1 tablet daily for 4 weeks of either the combination preparation or placebo and were then crossed over to the alternative medication for a further 4 weeks . The reduction in systolic and diastolic blood pressure both at rest , during maximal ergometric exercise and isometric word load , and also in the diurnal blood pressure profile over 24 hours was significantly greater in the group treated with the fixed-dose combination than in the placebo group . Pulse rate was also decreased to a greater extent . Mean diastolic blood pressure before exercise was reduced to normal ( 85.5 mmHg ) after 4-weeks ' treatment with the fixed-dose combination . Biochemical , haematological and urinary parameters showed no clinical ly relevant changes after either treatment . One patient complained of transient dizziness during treatment with the fixed-dose combination . No patient withdrew prematurely from the study because of side-effects Eighteen patients whose clinic blood pressure ( BP ) remained over 95 mmHg despite treatment with captopril 50 mg twice daily plus frusemide 40 mg twice daily were r and omised in a crossover study to four weeks ' treatment with once daily atenolol 100 mg , slow release propranolol 160 mg or placebo . The reduction in BP on atenolol was superior to that on both propranolol and placebo . The mean supine BP 24 hours post dosing were 177/110 mmHg ( placebo ) , 173/109 mmHg ( propranolol ) and 164/100 mmHg ( atenolol ) . The corresponding mean heart rates were 77 bpm ( placebo ) , 63 bpm ( propranolol ) and 62 bpm ( propranolol ) and 62 bpm ( atenolol ) . The difference in hypotensive efficacy between atenolol and propranolol is not readily explained but our study shows that atenolol has a clinical ly useful supplementary effect on BP . Refractory hypertension remains an important clinical problem and further studies are required to establish the optimum combination of drugs that should be used with captopril in order to achieve ' target ' BP in patients with moderate to severe hypertension BACKGROUND Contrast nephropathy ( CN ) is a common cause of renal dysfunction that may be prevented by saline hydration and by drugs such as theophylline or furosemide . Whether oral saline hydration is as efficient as intravenous saline hydration is unknown . The preventive efficacy of theophylline and furosemide for CN remains controversial . The purpose of the current study was to evaluate the efficacy of oral saline hydration and of intravenous saline hydration plus theophylline or furosemide for the prevention of CN . METHODS We prospect ively studied 312 patients with chronic renal failure ( serum creatinine 201+/-81 micromol/l , Cockcroft clearance 37+/-12 ml/min/1.73 m(2 ) ) , who were undergoing various radiological procedures with a non-ionic , low osmolality contrast agent . Patients were r and omly assigned to four arms . In arm A , patients received 1 g/10 kg of body weight/day of sodium chloride per os for 2 days before the procedure . In arm B , patients received 0.9 % saline intravenously at a rate of 15 ml/kg for 6 h before the procedure . In arm C , patients received the same saline hydration as in arm B plus 5 mg/kg theophylline per os in one dose 1 h before the procedure . In arm D , patients received the same saline hydration as in arm B plus 3 mg/kg of furosemide intravenously just after the procedure . RESULTS Patients were well-matched with no significant differences at baseline in any measured parameters .  Acute renal failure , defined as an increase in serum creatinine of 44 micromol/l ( 0.5 mg/dl ) , occurred in 27 out of 312 patients ( 8.7 % ) . There was no significant difference between the rate of renal failure in the different arms of the study : five out of 76 ( 6.6 % ) in arm A , four out of 77 ( 5.2 % ) in arm B , six out of 80 ( 7.5 % ) in arm C and 12 out of 79 ( 15.2 % ) in arm D. No patient had fluid overload or a significant increase in blood pressure in the 2 days following the radiological procedure . The independent predictors of CN were diabetes mellitus , high baseline serum creatinine and high systolic blood pressure . CONCLUSIONS Oral saline hydration was as efficient as intravenous saline hydration for the prevention of CN in patients with stage 3 renal diseases . Furosemide and theophylline were not protective Diuretics are frequently required to treat fluid retention in patients with congestive heart failure ( CHF ) . Unfortunately , they can lead to a decline in renal function , electrolyte depletion , and neurohumoral activation . Arginine vasopressin ( AVP ) promotes renal water reabsorption via the V2 receptor , and its levels are increased in CHF . This study was design ed to assess the effects of a single oral dose of tolvaptan , a selective V2-receptor blocker , in the absence of other medications , on renal function in human CHF and to compare this to the effects of a single oral dose of furosemide . We hypothesized that V2-receptor antagonism would yield a diuresis comparable to furosemide but would not adversely affect renal hemodynamics , plasma electrolyte concentration , or neurohumoral activation in stable human CHF . Renal and neurohumoral effects of tolvaptan and furosemide were assessed in an open-label , r and omized , placebo-controlled crossover study in 14 patients with NYHA II-III CHF . Patients received placebo or 30 mg of tolvaptan on day 1 and were crossed over to the other medication on day 3 . On day 5 , all subjects received 80 mg of furosemide . Tolvaptan and furosemide induced similar diuretic responses . Unlike tolvaptan , furosemide increased urinary sodium and potassium excretion and decreased renal blood flow .  Tolvaptan , furosemide , and placebo did not differ with respect to mean arterial pressure , glomerular filtration rate , or serum sodium and potassium . We conclude that tolvaptan is an effective aquaretic with no adverse effects on renal hemodynamics or serum electrolytes in patients with mild to moderate heart failure The antihypertensive effect and tolerability of enalaprilat , an intravenously administered angiotensin converting enzyme inhibitor , was studied in 65 patients with moderate or severe hypertension . In this r and omized , double-blind study , enalaprilat was compared with placebo in 42 ( 22 enalaprilat , 20 placebo )  moderate hypertensive ( diastolic blood pressure [ BP ] 100 to 114 mm Hg ) patients . It was compared with furosemide in 23 ( 12 enalaprilat , 11 furosemide ) severe hypertensive ( diastolic BP 115 to 130 mm Hg ) patients . Enalaprilat ( 1.25 or 5.0 mg ) , placebo ( 5 % dextrose ) or furosemide ( 40 or 80 mg ) was given every 6 hours intravenously up to 48 hours . In the moderate hypertension stratum , the mean supine diastolic BP was significantly ( p less than or equal to 0.01 ) reduced from baseline at all timepoints in the enalaprilat group . These diastolic BP reductions were significantly ( p less than or equal to 0.01 ) greater in the enalaprilat group than the placebo at 1 to 24 hours ( -12 vs -4 mm Hg ) , with 59 % of the patients responding to enalaprilat compared with 30 % of the patients responding to placebo . An even greater reduction ( p less than or equal to 0.01 ) was seen at 25 to 48 hours ( -14 vs -7 mm Hg , with 73 % enalaprilat vs 58 % placebo responders ) . Significant ( p less than or equal to 0.01 ) reductions in mean , supine systolic BP were also seen at 1 to 24 hours ( -22 vs -2 mm Hg ) and 25 to 48 hours ( -24 vs -8 mm Hg ) during the 48 hours of the double-blind treatment phase in the enalaprilat group compared with placebo . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND In chronic kidney disease ( CKD ) , loop di 
    Output:
    