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: Weight reduction was compared with metoprolol ( 200 mg daily ) in a r and omised placebo-controlled trial of first-line treatment of mild hypertension ( diastolic blood pressure 90 - 109 mm Hg ) in 56 overweight patients aged under 55 years . After 21 weeks of follow up the weight-reduction group had lost an average of 7.4 kg . The fall in their systolic pressure of 13 mm Hg was significantly greater than that in the placebo group ( 7 mm Hg ) but not different from that in the metoprolol group ( 10 mm Hg ) . Their fall in diastolic pressure ( 10 mm Hg ) was greater than that in both the metoprolol ( 6 mm Hg ) and placebo ( 3 mm Hg ) groups . At the end of the follow-up period 50 % of patients in the weight-reduction group had a diastolic pressure of less than 90 mm Hg . In the metoprolol group there was a decrease in high density lipoprotein (HDL)-cholesterol and an increase in the ratio of total to HDL-cholesterol ; in the weight-reduction group there was a decrease both in total cholesterol and in the ratio of total to HDL-cholesterol . Thus in this study population weight reduction produced significant and clinical ly important reductions in blood pressure but not the adverse effects on plasma lipids commonly associated with antihypertensive drug therapy We have examined the independent and combined effects on blood pressure and blood lipids of alcohol restriction and weight loss in overweight male drinkers with a view to assessing overall effects on cardiovascular risk of two widely promoted nonpharmacological approaches for hypertension . Eighty-six men with a mean age of 44.3 years , a mean regular alcohol intake of 440 ml/wk ( five or six st and ard drinks per day ) , a mean blood pressure of 137.4 mm Hg systolic and 84.8 mm Hg diastolic , and a mean body mass of 92.5 kg entered a controlled two-way factorial study . The subjects were r and omly assigned to four groups for an 18-week intervention in which members of two groups drank only low-alcohol beer , thereby reducing their alcohol intake  by 374 ml/wk , while those of the other two groups continued their normal alcohol intake . Within the low and normal alcohol intake groups subjects either continued their usual diet or reduced their caloric intake by 4,200 - 6,300 kJ/day ( 1,000 - 1,500 kcal/day ) ( with protein , fat , and carbohydrate provided as 15 % , 30 % , and 55 % of total calories , respectively ) . Calorie reduction and alcohol restriction caused weight losses of 7.5 ( p less than 0.001 ) and 2.1 ( p less than 0.01 ) kg , respectively . Calorie reduction and alcohol restriction were associated with decreases in systolic blood pressure of 5.4 ( p less than 0.001 ) and 4.8 ( p less than 0.01 ) mm Hg , respectively , and in diastolic blood pressure of 4.2 ( p less than 0.001 ) and 3.3 ( p less than 0.01 ) mm Hg , respectively . ( ABSTRACT TRUNCATED AT 250 WORDS The blood pressure responses of 19 mildly hypertensive ( diastolic blood pressure 90–104 mmHg ) individuals to treatment with either 1200 mg of elemental calcium supplementation or placebo were assessed weekly in a 6-month r and omized , double-blind , placebo-controlled crossover study . Both groups showed a decrease in blood pressure  ( calcium treated : 6 ± 12 mmHg systolic , 7 ± 7 mmHg diastolic ; and placebo controlled : 9 ± 14 mmHg systolic , 9 ± 8 mmHg diastolic ) . Differences between the two groups were not significant ( P > 0.1 ) . There were no adverse effects to either treatment . This study does not support the hypothesis that dietary calcium supplementation is more effective than placebo in reducing blood pressure in mildly hypertensive individuals BACKGROUND Several nonpharmacological interventions , including exercise , are recommended in primary prevention of hypertension and other cardiovascular diseases in which the pathogenetic role of endothelial dysfunction has been suggested . We studied the effects of long-term aerobic exercise on endothelial function in patients with essential hypertension . METHODS AND RESULTS The forearm blood flow was measured by strain-gauge plethysmography . The responses of forearm vasculature to acetylcholine were smaller in the hypertensive patients than in the normotensive subjects . There was no significant difference in forearm vascular responses to isosorbide dinitrate in the normotensive and hypertensive subjects . We evaluated the effects of physical exercise for 12 weeks on forearm hemodynamics in untreated patients with mild essential hypertension who were divided r and omly into an  exercise group ( n=10 ) and a control group ( n=7 ) . After 12 weeks , the forearm blood flow response to acetylcholine increased significantly , from 25.8+/-9.8 to 32.3+/-11.2 mL. min(-1 ) . 100 mL tissue(-1 ) ( P<0.05 ) , in the exercise group but not in the control group . The increase in the forearm blood flow after isosorbide dinitrate was similar before and after 12 weeks of follow-up in both groups . The infusion of N(G)-monomethyl-L-arginine abolished the exercise-induced enhancement of forearm vasorelaxation evoked by acetylcholine in the exercising group . In normotensive subjects also , long-term aerobic exercise augmented acetylcholine-stimulated nitric oxide release . CONCLUSIONS These findings suggest that long-term physical exercise improves endothelium-dependent vasorelaxation through an increase in the release of nitric oxide in normotensive as well as hypertensive subjects Meditation training appears to be a promising psychological approach to the control of hypertension . However , most studies to date have had serious deficiencies . This study attempted to correct many of these deficiencies . Forty-one unmedicated hypertensives referred by general practitioners were r and omly allocated to three groups . The treatment group ( SRELAX ) underwent training procedures based on Transcendental Meditation ; a placebo control group ( NSRELAX ) underwent identical training but without a mantra . Both procedures were compared with a no-treatment control group . The results showed modest reductions in blood pressure in both SRELAX and NSRELAX groups , compared with the no-treatment controls , with diastolic percentage reductions reaching significance ( p<0.05 ) . There was considerable subject variation in response , with overall a mean decline in diastolic blood pressure of 8–10 % on 3-month follow-up . Possible indicators to predict the response of subjects are considered and reasons for the similarity in the effectiveness of the SRELAX and NSRELAX conditions are discussed OBJECTIVE To determine the feasibility of conducting a r and omized clinical trial in the private practice setting examining short- and long-term effects of chiropractic adjustments for subjects with essential hypertension compared with a brief soft tissue massage , as well as a nontreatment control group . DESIGN R and omized controlled-comparison trial with 3 parallel groups . SETTING Private practice outpatient chiropractic clinic . PATIENTS Twenty-three subjects , aged 24 to 50 years with systolic or diastolic essential hypertension . INTERVENTIONS Two months of full-spine chiropractic care ( ie , Gonstead ) consisting primarily of specific-contact , short-lever-arm adjustments delivered at motion segments exhibiting signs of subluxation . The massage group had a brief effleurage procedure delivered at localized regions of the spine believed to be exhibiting signs of subluxation . The nontreatment control group rested alone for a period of approximately 5 minutes in an adjustment room . MAIN OUTCOME MEASURES Cost per enrolled subject , as well as systolic and diastolic blood pressure ( BP ) measured with a r and om-0 sphygmomanometer and patient reported health status ( SF-36 ) . Pilot study outcome measures also included an assessment of cooperation of subjects to r and omization procedures and drop-out rates , recruitment effectiveness , analysis of temporal stability of BPs at the beginning of care , and the effects of inclusion /exclusion criteria on the subject pool . RESULTS Thirty subjects enrolled , yielding a cost of $ 161 per enrolled subject . One subject was later determined to be ineligible , and 6 others dropped out . In both the chiropractic and massage therapy groups , all subjects were classified as either overweight or obese ; in the control group there were only 2 classified as such . SF-36 profiles for the groups were similar to that of a normal population . The mean change in diastolic BP was -4 ( 95 % confidence interval [ CI ] : -8.6 , 0.5 ) in the chiropractic care group , 0.5 ( 95 % CI : -3.5 , 4.5 ) in the brief massage treatment group , and -4.9 ( 95 % CI : -9.7 , -0.1 ) in the no treatment control group . At the end of the study period , this change was -6.3 ( 95 % CI : 13.1 , 0.4 ) , -1.0 ( 95 % CI : -7.5 , 15.6 ) , -7.2 ( 95 % CI : -13.3 , -1.1 ) in the 3 study groups . The mean improvements in the chiropractic care and no treatment control groups remained consistent over the follow-up period . CONCLUSIONS This pilot study eluci date d several procedural issues that should be addressed before undertaking a full-scale clinical trial on the effects of chiropractic adjustments in patients with essential hypertension . A multidisciplinary approach to recruitment may need to be used in any future efforts because of the limited subject pool of patients who have hypertensive disease but are not taking medications for its control . Measures need to be used to assure comparable groups regarding prognostic variables such as weight . Studies such as these demonstrate the feasibility of conducting a full-scale 3-group r and omized clinical trial in the private practice setting To determine the antihypertensive efficacy of aerobic exercise training in mild essential hypertension , a prospect i ve r and omized controlled trial was conducted comparing an aerobic exercise regimen to a placebo exercise regimen , with a crossover replication of the aerobic regimen in the placebo exercise group . The study took place in an outpatient research clinic in a university-affiliated Veterans Administration medical center . Twenty-seven men with untreated diastolic blood pressure ( DBP ) of 90 - 104 mm Hg were r and omized to the two exercise regimens . Ten patients completed the aerobic regimen .  Nine patients completed the control regimen , seven of whom subsequently entered and completed the aerobic regimen . The aerobic regimen consisted of walking , jogging , stationary bicycling , or any combination of these activities for 30 minutes , four times a week , at 65 - 80 % maximal heart rate . The control regimen consisted of slow calisthenics and stretching for the same duration and frequency but maintaining less than 60 % maximal heart rate . DBP decreased 9.6 + /- 4.7 mm Hg in the aerobic exercise group but increased 0.8 + /- 6.2 mm Hg in the placebo control exercise group ( p = 0.02 ) . Systolic blood pressure ( SBP ) decreased 6.4 + /- 9.1 mm Hg in the aerobic group and increased 0.9 + /- 9.7 mm Hg in the control group ( p = 0.11 ) . Subsequently , seven of the nine controls entered a treatment crossover and completed the aerobic regimen with significant reductions in both DBP ( -6.1 + /- 3.2 mm Hg , p less than 0.01 ) and SBP ( -8.1 + /- 5.7 mm Hg , p less than 0.01 ) . BP changes were not associated with any significant changes in weight , body fat , urinary electrolytes , or resting heart rate . This r and omized controlled trial provides evidence for the independent BP lowering effect of aerobic exercise in unmedicated mildly hypertensive men Dietary intakes of potassium , calcium , and magnesium have each been reported to lower blood pressure , but the extent of blood pressure reduction in epidemiological studies and clinical trials has tended to be small and inconsistent . We hypothesized that combinations of these mineral supplements would lower blood pressure and that the reductions would be greater than that usually reported in studies of each cation alone . One hundred twenty-five patients 82 men and 43 women ) with untreated mild or borderline hypertension were r and omly assigned to daily treatment with one of the following four regimens : 60 mmol potassium and 25 mmol ( 1000 mg ) calcium , 60 mmol potassium and 15 mmol ( 360 mg ) magnesium , calcium and magnesium , or placebo .  St and ardized clinic blood pressure measurements were obtained on 3 days at baseline and after 3 and 6 months of treatment . At baseline , systolic and diastolic blood pressures ( mean + /- SD ) were 139 + /- 12 and 90 + /- 4 mm Hg , respectively , and dietary intakes of potassium , calcium , and magnesium were 77 + /- 32 , 19 + /- 13 , and 12 + /- 52 mmol/d , respectively . 
    Output:
    
agent
Robust statistically significant effects were found for improved diet , aerobic exercise , alcohol and sodium restriction , and fish oil supplements : mean reductions in systolic blood pressure of 5.0 mmHg [ 95 % confidence interval ( CI ) : 3.1 - 7.0 ] , 4.6 mmHg ( 95 % CI : 2.0 - 7.1 ) , 3.8 mmHg ( 95 % CI : 1.4 - 6.1 ) , 3.6 mmHg ( 95 % CI : 2.5 - 4.6 ) and 2.3 mmHg ( 95 % CI : 0.2 - 4.3 ) , respectively , with corresponding reductions in diastolic blood pressure .
Relaxation significantly reduced blood pressure only when compared with non-intervention controls .
We found no robust evidence of any important effect on blood pressure of potassium , magnesium or calcium supplements .
Available evidence does not support relaxation therapies , calcium , magnesium or potassium supplements to reduce blood pressure
***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: Weight reduction was compared with metoprolol ( 200 mg daily ) in a r and omised placebo-controlled trial of first-line treatment of mild hypertension ( diastolic blood pressure 90 - 109 mm Hg ) in 56 overweight patients aged under 55 years . After 21 weeks of follow up the weight-reduction group had lost an average of 7.4 kg . The fall in their systolic pressure of 13 mm Hg was significantly greater than that in the placebo group ( 7 mm Hg ) but not different from that in the metoprolol group ( 10 mm Hg ) . Their fall in diastolic pressure ( 10 mm Hg ) was greater than that in both the metoprolol ( 6 mm Hg ) and placebo ( 3 mm Hg ) groups . At the end of the follow-up period 50 % of patients in the weight-reduction group had a diastolic pressure of less than 90 mm Hg . In the metoprolol group there was a decrease in high density lipoprotein (HDL)-cholesterol and an increase in the ratio of total to HDL-cholesterol ; in the weight-reduction group there was a decrease both in total cholesterol and in the ratio of total to HDL-cholesterol . Thus in this study population weight reduction produced significant and clinical ly important reductions in blood pressure but not the adverse effects on plasma lipids commonly associated with antihypertensive drug therapy We have examined the independent and combined effects on blood pressure and blood lipids of alcohol restriction and weight loss in overweight male drinkers with a view to assessing overall effects on cardiovascular risk of two widely promoted nonpharmacological approaches for hypertension . Eighty-six men with a mean age of 44.3 years , a mean regular alcohol intake of 440 ml/wk ( five or six st and ard drinks per day ) , a mean blood pressure of 137.4 mm Hg systolic and 84.8 mm Hg diastolic , and a mean body mass of 92.5 kg entered a controlled two-way factorial study . The subjects were r and omly assigned to four groups for an 18-week intervention in which members of two groups drank only low-alcohol beer , thereby reducing their alcohol intake  by 374 ml/wk , while those of the other two groups continued their normal alcohol intake . Within the low and normal alcohol intake groups subjects either continued their usual diet or reduced their caloric intake by 4,200 - 6,300 kJ/day ( 1,000 - 1,500 kcal/day ) ( with protein , fat , and carbohydrate provided as 15 % , 30 % , and 55 % of total calories , respectively ) . Calorie reduction and alcohol restriction caused weight losses of 7.5 ( p less than 0.001 ) and 2.1 ( p less than 0.01 ) kg , respectively . Calorie reduction and alcohol restriction were associated with decreases in systolic blood pressure of 5.4 ( p less than 0.001 ) and 4.8 ( p less than 0.01 ) mm Hg , respectively , and in diastolic blood pressure of 4.2 ( p less than 0.001 ) and 3.3 ( p less than 0.01 ) mm Hg , respectively . ( ABSTRACT TRUNCATED AT 250 WORDS The blood pressure responses of 19 mildly hypertensive ( diastolic blood pressure 90–104 mmHg ) individuals to treatment with either 1200 mg of elemental calcium supplementation or placebo were assessed weekly in a 6-month r and omized , double-blind , placebo-controlled crossover study . Both groups showed a decrease in blood pressure  ( calcium treated : 6 ± 12 mmHg systolic , 7 ± 7 mmHg diastolic ; and placebo controlled : 9 ± 14 mmHg systolic , 9 ± 8 mmHg diastolic ) . Differences between the two groups were not significant ( P > 0.1 ) . There were no adverse effects to either treatment . This study does not support the hypothesis that dietary calcium supplementation is more effective than placebo in reducing blood pressure in mildly hypertensive individuals BACKGROUND Several nonpharmacological interventions , including exercise , are recommended in primary prevention of hypertension and other cardiovascular diseases in which the pathogenetic role of endothelial dysfunction has been suggested . We studied the effects of long-term aerobic exercise on endothelial function in patients with essential hypertension . METHODS AND RESULTS The forearm blood flow was measured by strain-gauge plethysmography . The responses of forearm vasculature to acetylcholine were smaller in the hypertensive patients than in the normotensive subjects . There was no significant difference in forearm vascular responses to isosorbide dinitrate in the normotensive and hypertensive subjects . We evaluated the effects of physical exercise for 12 weeks on forearm hemodynamics in untreated patients with mild essential hypertension who were divided r and omly into an  exercise group ( n=10 ) and a control group ( n=7 ) . After 12 weeks , the forearm blood flow response to acetylcholine increased significantly , from 25.8+/-9.8 to 32.3+/-11.2 mL. min(-1 ) . 100 mL tissue(-1 ) ( P<0.05 ) , in the exercise group but not in the control group . The increase in the forearm blood flow after isosorbide dinitrate was similar before and after 12 weeks of follow-up in both groups . The infusion of N(G)-monomethyl-L-arginine abolished the exercise-induced enhancement of forearm vasorelaxation evoked by acetylcholine in the exercising group . In normotensive subjects also , long-term aerobic exercise augmented acetylcholine-stimulated nitric oxide release . CONCLUSIONS These findings suggest that long-term physical exercise improves endothelium-dependent vasorelaxation through an increase in the release of nitric oxide in normotensive as well as hypertensive subjects Meditation training appears to be a promising psychological approach to the control of hypertension . However , most studies to date have had serious deficiencies . This study attempted to correct many of these deficiencies . Forty-one unmedicated hypertensives referred by general practitioners were r and omly allocated to three groups . The treatment group ( SRELAX ) underwent training procedures based on Transcendental Meditation ; a placebo control group ( NSRELAX ) underwent identical training but without a mantra . Both procedures were compared with a no-treatment control group . The results showed modest reductions in blood pressure in both SRELAX and NSRELAX groups , compared with the no-treatment controls , with diastolic percentage reductions reaching significance ( p<0.05 ) . There was considerable subject variation in response , with overall a mean decline in diastolic blood pressure of 8–10 % on 3-month follow-up . Possible indicators to predict the response of subjects are considered and reasons for the similarity in the effectiveness of the SRELAX and NSRELAX conditions are discussed OBJECTIVE To determine the feasibility of conducting a r and omized clinical trial in the private practice setting examining short- and long-term effects of chiropractic adjustments for subjects with essential hypertension compared with a brief soft tissue massage , as well as a nontreatment control group . DESIGN R and omized controlled-comparison trial with 3 parallel groups . SETTING Private practice outpatient chiropractic clinic . PATIENTS Twenty-three subjects , aged 24 to 50 years with systolic or diastolic essential hypertension . INTERVENTIONS Two months of full-spine chiropractic care ( ie , Gonstead ) consisting primarily of specific-contact , short-lever-arm adjustments delivered at motion segments exhibiting signs of subluxation . The massage group had a brief effleurage procedure delivered at localized regions of the spine believed to be exhibiting signs of subluxation . The nontreatment control group rested alone for a period of approximately 5 minutes in an adjustment room . MAIN OUTCOME MEASURES Cost per enrolled subject , as well as systolic and diastolic blood pressure ( BP ) measured with a r and om-0 sphygmomanometer and patient reported health status ( SF-36 ) . Pilot study outcome measures also included an assessment of cooperation of subjects to r and omization procedures and drop-out rates , recruitment effectiveness , analysis of temporal stability of BPs at the beginning of care , and the effects of inclusion /exclusion criteria on the subject pool . RESULTS Thirty subjects enrolled , yielding a cost of $ 161 per enrolled subject . One subject was later determined to be ineligible , and 6 others dropped out . In both the chiropractic and massage therapy groups , all subjects were classified as either overweight or obese ; in the control group there were only 2 classified as such . SF-36 profiles for the groups were similar to that of a normal population . The mean change in diastolic BP was -4 ( 95 % confidence interval [ CI ] : -8.6 , 0.5 ) in the chiropractic care group , 0.5 ( 95 % CI : -3.5 , 4.5 ) in the brief massage treatment group , and -4.9 ( 95 % CI : -9.7 , -0.1 ) in the no treatment control group . At the end of the study period , this change was -6.3 ( 95 % CI : 13.1 , 0.4 ) , -1.0 ( 95 % CI : -7.5 , 15.6 ) , -7.2 ( 95 % CI : -13.3 , -1.1 ) in the 3 study groups . The mean improvements in the chiropractic care and no treatment control groups remained consistent over the follow-up period . CONCLUSIONS This pilot study eluci date d several procedural issues that should be addressed before undertaking a full-scale clinical trial on the effects of chiropractic adjustments in patients with essential hypertension . A multidisciplinary approach to recruitment may need to be used in any future efforts because of the limited subject pool of patients who have hypertensive disease but are not taking medications for its control . Measures need to be used to assure comparable groups regarding prognostic variables such as weight . Studies such as these demonstrate the feasibility of conducting a full-scale 3-group r and omized clinical trial in the private practice setting To determine the antihypertensive efficacy of aerobic exercise training in mild essential hypertension , a prospect i ve r and omized controlled trial was conducted comparing an aerobic exercise regimen to a placebo exercise regimen , with a crossover replication of the aerobic regimen in the placebo exercise group . The study took place in an outpatient research clinic in a university-affiliated Veterans Administration medical center . Twenty-seven men with untreated diastolic blood pressure ( DBP ) of 90 - 104 mm Hg were r and omized to the two exercise regimens . Ten patients completed the aerobic regimen .  Nine patients completed the control regimen , seven of whom subsequently entered and completed the aerobic regimen . The aerobic regimen consisted of walking , jogging , stationary bicycling , or any combination of these activities for 30 minutes , four times a week , at 65 - 80 % maximal heart rate . The control regimen consisted of slow calisthenics and stretching for the same duration and frequency but maintaining less than 60 % maximal heart rate . DBP decreased 9.6 + /- 4.7 mm Hg in the aerobic exercise group but increased 0.8 + /- 6.2 mm Hg in the placebo control exercise group ( p = 0.02 ) . Systolic blood pressure ( SBP ) decreased 6.4 + /- 9.1 mm Hg in the aerobic group and increased 0.9 + /- 9.7 mm Hg in the control group ( p = 0.11 ) . Subsequently , seven of the nine controls entered a treatment crossover and completed the aerobic regimen with significant reductions in both DBP ( -6.1 + /- 3.2 mm Hg , p less than 0.01 ) and SBP ( -8.1 + /- 5.7 mm Hg , p less than 0.01 ) . BP changes were not associated with any significant changes in weight , body fat , urinary electrolytes , or resting heart rate . This r and omized controlled trial provides evidence for the independent BP lowering effect of aerobic exercise in unmedicated mildly hypertensive men Dietary intakes of potassium , calcium , and magnesium have each been reported to lower blood pressure , but the extent of blood pressure reduction in epidemiological studies and clinical trials has tended to be small and inconsistent . We hypothesized that combinations of these mineral supplements would lower blood pressure and that the reductions would be greater than that usually reported in studies of each cation alone . One hundred twenty-five patients 82 men and 43 women ) with untreated mild or borderline hypertension were r and omly assigned to daily treatment with one of the following four regimens : 60 mmol potassium and 25 mmol ( 1000 mg ) calcium , 60 mmol potassium and 15 mmol ( 360 mg ) magnesium , calcium and magnesium , or placebo .  St and ardized clinic blood pressure measurements were obtained on 3 days at baseline and after 3 and 6 months of treatment . At baseline , systolic and diastolic blood pressures ( mean + /- SD ) were 139 + /- 12 and 90 + /- 4 mm Hg , respectively , and dietary intakes of potassium , calcium , and magnesium were 77 + /- 32 , 19 + /- 13 , and 12 + /- 52 mmol/d , respectively . 
    Output:
    