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: OBJECTIVES The CORD trials tested ramipril and losartan in patients with hypertension . PATIENTS AND METHODS CORD IA involving switching from an angiotensin-converting enzyme inhibitor ( ACEI ) to the angiotensin II receptor blocker ( ARB ) losartan .  4,016 patients with blood pressure ( BP ) < 160/100 mm Hg who had been treated with an ACEI for > 3 months were enrolled . The mean age was 62.6 + /- 11.6 years and 53.1 % were women . The patients discontinued ACEI and switched to losartan 50 mg once daily .  BP , heart rate , biochemistry , blood counts and ECGs were measured at day 1 and months 1 , 3 , 6 and 12 . If the BP was > or = 140/90 mm Hg after 1 month or more , the dose of losartan was increased to 100 mg . After 1 month the BP decreased from 147.4 + /- 14.8/87.7 + /- 9.3 mm Hg to 139.7 + /- 11.8/83.0 + /- 9.3 mm Hg ( p < 0.001 ) and after 1 year to 133.7 + /- 11.3/79.1 + /- 7.06 mm Hg ( p < 0.001 ) . The rate of adverse events did not significantly increase and no changes in plasma sodium , potassium , urea or creatinine were observed . CORD IB compared ramipril and losartan . 3,813 patients with BP > or = 140/90 mm Hg who were not being treated with an ACEI or ARB were enrolled . The mean age was 60.5 + /- 12.2 years and 50.5 % were women . The patients were r and omised to ramipril 5 mg ( n = 1,926 ) or losartan 50 mg ( n = 1,887 ) . The dose was doubled if BP after 1 month was > or = 140/90 mm Hg . If the BP after 3 months still was > or = 140/90 mm Hg , another antihypertensive drug was added , typically athiazide diuretic . RESULTS After 1 yearthe BP decreased in the ramipril group from 155.9 + /- 13.1/93.0 + /- 8.9 mm Hg to 134.1 + /- 11.2/81.5 + /- 6.8 mm Hg ( p < 0.001 ) and in the losartan group from 156.5 + /- 13.1/93.4 + /- 8.8 to 134.55 + /- 11.3/80.16 + /- 6.6 mm Hg ( p < 0.001 ) . No significant differences were found between the groups . A slight increase in plasma potassium ( 0.2 mmol in both groups ) and urea ( 0.3 mmol in both groups ) was observed , but no change in plasma creatinine . There was a small , insignificant decrease in plasma uric acid ( in the ramipril group from 325.5 to 320.7 micromol/l and in the losartan group from 321.6 to 318.3 micromol/l ) and a slight decrease in plasma glucose and triglycerides ( 0.2 mmol/l in both measures in both groups ) . No severe adverse events were observed , but dry cough was 8 times more frequently reported in the ramipril group . CONCLUSION CORD IA confirmed that switching from an ACEI to losartan is safe and effective . Titrating the dose upwards or adding diuretics leads to good BP control in the majority of patients ( 2/3 ) . CORD IB showed no differences between ramipril and losartan in lowering BP and both drugs showed a trend to improve metabolic parameters such as glycaemia , triglyceridaemia and uric acid equally . Dry cough was more frequent after ACEI BACKGROUND This study compared the effect of antihypertensive treatment with valsartan or ramipril on  atrial fibrillation ( AF ) recurrence  , on P-wave dispersion , ( PWD ) and on serum procollagen type I carboxy terminal peptide ( PIP ) . METHODS A total of 369 mild hypertensive ( systolic blood pressure ( SBP ) > 140 and /or 90 < diastolic blood pressure ( DBP ) < 110 mm Hg ) out patients in sinus rhythm but with at least two episodes of AF in the previous 6 months were r and omized to valsartan ( n = 122 ) , ramipril  ( n = 124 ) , or amlodipine  ( n = 123 ) for 1 year . Clinic blood pressure ( BP ) and a 24-h electrocardiogram ( ECG )  were evaluated monthly . Patients were asked to report any episode of symptomatic AF and to perform an ECG as early as possible . PWD and serum PIP levels were evaluated before and after each treatment period . RESULTS SBP and DBP were significantly reduced by the three treatments ( P < 0.001 ) . A total of 46 ( 47.4 % ) patients treated with amlodipine had a recurrence of AF as did 26 ( 27.9 % ) patients treated with ramipril ( P < 0.01 vs. amlodipine ) and 16 ( 16.1 % ) patients treated with valsartan ( P < 0.01 vs. amlodipine and P < 0.05 vs. ramipril ) . The Kaplan-Meyer analysis showed a significant reduction of AF episodes in the valsartan group ( P = 0.005 log-rank test ) as well as in the ramipril group ( P = 0.021 ) , even if at a lesser degree . PWD values were significantly reduced by ramipril ( -4.2 ms , P < 0.05 ) and even more by valsartan ( -11.2 ms , P < 0.01 ) , the difference being significant ( P < 0.01 ) . Serum PIP levels were reduced by ramipril ( -49.7 microg , P < 0.001 ) and valsartan ( -49.3 microg , P < 0.001 ) . CONCLUSIONS Despite similar BP lowering , valsartan and ramipril were more effective than amlodipine in preventing new episodes of AF , but the effect of valsartan was greater than that of ramipril . This could be related to the greater PWD reduction observed with valsartan BACKGROUND Few studies have directly compared the renoprotective effects of angiotensin II-receptor blockers and angiotensin-converting-enzyme ( ACE ) inhibitors in persons with type 2 diabetes . METHODS In this prospect i ve , multicenter , double-blind , five-year study , we r and omly assigned 250 subjects with type 2 diabetes and early nephropathy to receive either the angiotensin II-receptor blocker telmisartan ( 80 mg daily , in 120 subjects ) or the ACE inhibitor enalapril ( 20 mg daily , in 130 subjects ) . The primary end point was the change in the glomerular filtration rate ( determined by measuring the plasma clearance of iohexol ) between the baseline value and the last available value during the five-year treatment period . Secondary end points included the annual changes in the glomerular filtration rate , serum creatinine level , urinary albumin excretion , and blood pressure ; the rates of end-stage renal disease and cardiovascular events ; and the rate of death from all causes . RESULTS After five years , the change in the glomerular filtration rate was -17.5 ml per minute per 1.73 m2 ( where the minus sign denotes a decrement ) in the telmisartan-treated subjects , as compared with -15.0 ml per minute per 1.73 m2 in the enalapril-treated subjects ; the treatment difference was thus -2.6 ml per minute per 1.73 m2 ( 95 percent confidence interval , -7.1 to 2.0 ml per minute per 1.73 m2)[corrected ] The lower boundary of the confidence interval , in favor of enalapril , was greater than the predefined margin of -10.0 ml per minute per 1.73 m2 , indicating that telmisartan was not inferior to enalapril . The effects of the two agents on the secondary end points were not significantly different after five years . CONCLUSIONS Telmisartan is not inferior to enalapril in providing long-term renoprotection in persons with type 2 diabetes . These findings do not necessarily apply to persons with more advanced nephropathy , but they support the clinical equivalence of angiotensin II-receptor blockers and ACE inhibitors in persons with conditions that place them at high risk for cardiovascular events Angiotensin-converting enzyme ( ACE ) inhibitors have favourable effects on hypertension and diabetic nephropathy , but persistent use may result in incomplete blockade of the renin-angiotensin system . Long-term effects of dual blockade using the ACE inhibitor lisinopril and the long-acting angiotensin II receptor blocker ( ARB ) telmisartan on blood pressure and albumin excretion rate ( AER ) were evaluated . Patients with type 2 diabetes mellitus , hypertension ( systolic blood pressure [ SBP ] > or=140 mmHg or diastolic blood pressure [ DBP ] > or=90 mmHg ) and microalbuminuria ( AER 30 - 300 mg/24h ) received 20 mg of lisinopril or 80 mg of telmisartan once a day for 24 weeks . Patients were then r and omised to continuing treatment with the respective monotherapy or with lisinopril plus telmisartan for a further 28 weeks . Significant ( P<0.001 ) declines in SBP ( 11.1 mmHg versus 10.0 mmHg ) , DBP ( 5.6 mmHg versus 5.3 mmHg ) and AER ( 98 mg/24 h versus 80 mg/24 h ) were achieved with lisinopril ( n=95 ) or telmisartan ( n=97 ) , respectively , after 24 weeks . Subsequent treatment with lisinopril plus telmisartan for 28 weeks result ed in further significant reductions ( P<0.001 ) in SBP , DBP and AER compared with either monotherapy . All treatments were well tolerated . Lisinopril plus telmisartan thus provides superior blood pressure and AER control than either monotherapy . We conclude that use of dual blockade may provide a new approach to prevention of diabetic nephropathy in patients with type 2 diabetes , hypertension and microalbuminuria Background : Although heart failure with a preserved or normal ejection fraction ( HFNEF or diastolic heart failure ) is common , treatment outcomes on quality of life and cardiac function are lacking . The effect of renin – angiotensin blockade by irbesartan or ramipril in combination with diuretics on quality of life ( QoL ) , regional and global systolic and diastolic function was assessed in HFNEF patients . Methods : 150 patients with HFNEF ( LVEF > 45 % ) were r and omised to ( 1 )  diuretics alone , ( 2 ) diuretics plus irbesartan , or ( 3 ) diuretics plus ramipril .  QoL , 6-minute walk test ( 6MWT ) and Doppler echocardiography were performed at baseline , 12 , 24 and 52 weeks . Results : The QoL score improved similarly in all three groups by 52 weeks ( −46 % , 51 % , and 50 % respectively , all p<0.01 ) , although 6MWT increased only slightly ( average + 3–6 % ) . Recurrent hospitalisation rates were equal in all groups ( 10–12 % in 1 year ) . At 1 year , LV dimensions or LVEF had not changed in any group , though both systolic and diastolic blood pressures were lowered in all three groups from 4 weeks onwards . At baseline both mean peak systolic ( Sm ) and early diastolic ( Em ) mitral annulus velocities were reduced , and increased slightly in the diuretic plus irbesartan ( Sm 4.5 ( SEM 0.17 ) to 4.9 ( SEM 0.16 ) cm/sec ; Em 3.8 ( SEM 0.25 ) to 4.2 ( SEM 0.25 ) cm/sec ) and ramipril ( Sm 4.5 ( SEM 0.24 ) to 4.9 ( SEM 0.20 ) cm/sec ; Em 3.3 ( SEM 0.25 ) to 4.04 ( SEM 0.32 ) cm/sec ) groups ( both p<0.05 ) . NT-pro-BNP levels were raised at baseline ( 595 ( SD 905 ) pg/ml ; range 5–4748 ) and fell in the irbesartan ( −124 ( SD 302 ) pg/ml , p = 0.01 ) and ramipril ( −173 ( SD 415 ) pg/ml , p = 0.03 ) groups only . Conclusions : In this typically elderly group 
    Output:
    
agent
Our analyses found no evidence of a difference in total mortality or cardiovascular outcomes for ARBs as compared with ACE inhibitors , while ARBs caused slightly fewer WDAEs than ACE inhibitors .
Although ACE inhibitors have shown efficacy in these outcomes over placebo , our results can not be used to extrapolate the same conclusion for ARBs directly , which have not been studied in placebo-controlled trials for hypertension .
***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: OBJECTIVES The CORD trials tested ramipril and losartan in patients with hypertension . PATIENTS AND METHODS CORD IA involving switching from an angiotensin-converting enzyme inhibitor ( ACEI ) to the angiotensin II receptor blocker ( ARB ) losartan .  4,016 patients with blood pressure ( BP ) < 160/100 mm Hg who had been treated with an ACEI for > 3 months were enrolled . The mean age was 62.6 + /- 11.6 years and 53.1 % were women . The patients discontinued ACEI and switched to losartan 50 mg once daily .  BP , heart rate , biochemistry , blood counts and ECGs were measured at day 1 and months 1 , 3 , 6 and 12 . If the BP was > or = 140/90 mm Hg after 1 month or more , the dose of losartan was increased to 100 mg . After 1 month the BP decreased from 147.4 + /- 14.8/87.7 + /- 9.3 mm Hg to 139.7 + /- 11.8/83.0 + /- 9.3 mm Hg ( p < 0.001 ) and after 1 year to 133.7 + /- 11.3/79.1 + /- 7.06 mm Hg ( p < 0.001 ) . The rate of adverse events did not significantly increase and no changes in plasma sodium , potassium , urea or creatinine were observed . CORD IB compared ramipril and losartan . 3,813 patients with BP > or = 140/90 mm Hg who were not being treated with an ACEI or ARB were enrolled . The mean age was 60.5 + /- 12.2 years and 50.5 % were women . The patients were r and omised to ramipril 5 mg ( n = 1,926 ) or losartan 50 mg ( n = 1,887 ) . The dose was doubled if BP after 1 month was > or = 140/90 mm Hg . If the BP after 3 months still was > or = 140/90 mm Hg , another antihypertensive drug was added , typically athiazide diuretic . RESULTS After 1 yearthe BP decreased in the ramipril group from 155.9 + /- 13.1/93.0 + /- 8.9 mm Hg to 134.1 + /- 11.2/81.5 + /- 6.8 mm Hg ( p < 0.001 ) and in the losartan group from 156.5 + /- 13.1/93.4 + /- 8.8 to 134.55 + /- 11.3/80.16 + /- 6.6 mm Hg ( p < 0.001 ) . No significant differences were found between the groups . A slight increase in plasma potassium ( 0.2 mmol in both groups ) and urea ( 0.3 mmol in both groups ) was observed , but no change in plasma creatinine . There was a small , insignificant decrease in plasma uric acid ( in the ramipril group from 325.5 to 320.7 micromol/l and in the losartan group from 321.6 to 318.3 micromol/l ) and a slight decrease in plasma glucose and triglycerides ( 0.2 mmol/l in both measures in both groups ) . No severe adverse events were observed , but dry cough was 8 times more frequently reported in the ramipril group . CONCLUSION CORD IA confirmed that switching from an ACEI to losartan is safe and effective . Titrating the dose upwards or adding diuretics leads to good BP control in the majority of patients ( 2/3 ) . CORD IB showed no differences between ramipril and losartan in lowering BP and both drugs showed a trend to improve metabolic parameters such as glycaemia , triglyceridaemia and uric acid equally . Dry cough was more frequent after ACEI BACKGROUND This study compared the effect of antihypertensive treatment with valsartan or ramipril on  atrial fibrillation ( AF ) recurrence  , on P-wave dispersion , ( PWD ) and on serum procollagen type I carboxy terminal peptide ( PIP ) . METHODS A total of 369 mild hypertensive ( systolic blood pressure ( SBP ) > 140 and /or 90 < diastolic blood pressure ( DBP ) < 110 mm Hg ) out patients in sinus rhythm but with at least two episodes of AF in the previous 6 months were r and omized to valsartan ( n = 122 ) , ramipril  ( n = 124 ) , or amlodipine  ( n = 123 ) for 1 year . Clinic blood pressure ( BP ) and a 24-h electrocardiogram ( ECG )  were evaluated monthly . Patients were asked to report any episode of symptomatic AF and to perform an ECG as early as possible . PWD and serum PIP levels were evaluated before and after each treatment period . RESULTS SBP and DBP were significantly reduced by the three treatments ( P < 0.001 ) . A total of 46 ( 47.4 % ) patients treated with amlodipine had a recurrence of AF as did 26 ( 27.9 % ) patients treated with ramipril ( P < 0.01 vs. amlodipine ) and 16 ( 16.1 % ) patients treated with valsartan ( P < 0.01 vs. amlodipine and P < 0.05 vs. ramipril ) . The Kaplan-Meyer analysis showed a significant reduction of AF episodes in the valsartan group ( P = 0.005 log-rank test ) as well as in the ramipril group ( P = 0.021 ) , even if at a lesser degree . PWD values were significantly reduced by ramipril ( -4.2 ms , P < 0.05 ) and even more by valsartan ( -11.2 ms , P < 0.01 ) , the difference being significant ( P < 0.01 ) . Serum PIP levels were reduced by ramipril ( -49.7 microg , P < 0.001 ) and valsartan ( -49.3 microg , P < 0.001 ) . CONCLUSIONS Despite similar BP lowering , valsartan and ramipril were more effective than amlodipine in preventing new episodes of AF , but the effect of valsartan was greater than that of ramipril . This could be related to the greater PWD reduction observed with valsartan BACKGROUND Few studies have directly compared the renoprotective effects of angiotensin II-receptor blockers and angiotensin-converting-enzyme ( ACE ) inhibitors in persons with type 2 diabetes . METHODS In this prospect i ve , multicenter , double-blind , five-year study , we r and omly assigned 250 subjects with type 2 diabetes and early nephropathy to receive either the angiotensin II-receptor blocker telmisartan ( 80 mg daily , in 120 subjects ) or the ACE inhibitor enalapril ( 20 mg daily , in 130 subjects ) . The primary end point was the change in the glomerular filtration rate ( determined by measuring the plasma clearance of iohexol ) between the baseline value and the last available value during the five-year treatment period . Secondary end points included the annual changes in the glomerular filtration rate , serum creatinine level , urinary albumin excretion , and blood pressure ; the rates of end-stage renal disease and cardiovascular events ; and the rate of death from all causes . RESULTS After five years , the change in the glomerular filtration rate was -17.5 ml per minute per 1.73 m2 ( where the minus sign denotes a decrement ) in the telmisartan-treated subjects , as compared with -15.0 ml per minute per 1.73 m2 in the enalapril-treated subjects ; the treatment difference was thus -2.6 ml per minute per 1.73 m2 ( 95 percent confidence interval , -7.1 to 2.0 ml per minute per 1.73 m2)[corrected ] The lower boundary of the confidence interval , in favor of enalapril , was greater than the predefined margin of -10.0 ml per minute per 1.73 m2 , indicating that telmisartan was not inferior to enalapril . The effects of the two agents on the secondary end points were not significantly different after five years . CONCLUSIONS Telmisartan is not inferior to enalapril in providing long-term renoprotection in persons with type 2 diabetes . These findings do not necessarily apply to persons with more advanced nephropathy , but they support the clinical equivalence of angiotensin II-receptor blockers and ACE inhibitors in persons with conditions that place them at high risk for cardiovascular events Angiotensin-converting enzyme ( ACE ) inhibitors have favourable effects on hypertension and diabetic nephropathy , but persistent use may result in incomplete blockade of the renin-angiotensin system . Long-term effects of dual blockade using the ACE inhibitor lisinopril and the long-acting angiotensin II receptor blocker ( ARB ) telmisartan on blood pressure and albumin excretion rate ( AER ) were evaluated . Patients with type 2 diabetes mellitus , hypertension ( systolic blood pressure [ SBP ] > or=140 mmHg or diastolic blood pressure [ DBP ] > or=90 mmHg ) and microalbuminuria ( AER 30 - 300 mg/24h ) received 20 mg of lisinopril or 80 mg of telmisartan once a day for 24 weeks . Patients were then r and omised to continuing treatment with the respective monotherapy or with lisinopril plus telmisartan for a further 28 weeks . Significant ( P<0.001 ) declines in SBP ( 11.1 mmHg versus 10.0 mmHg ) , DBP ( 5.6 mmHg versus 5.3 mmHg ) and AER ( 98 mg/24 h versus 80 mg/24 h ) were achieved with lisinopril ( n=95 ) or telmisartan ( n=97 ) , respectively , after 24 weeks . Subsequent treatment with lisinopril plus telmisartan for 28 weeks result ed in further significant reductions ( P<0.001 ) in SBP , DBP and AER compared with either monotherapy . All treatments were well tolerated . Lisinopril plus telmisartan thus provides superior blood pressure and AER control than either monotherapy . We conclude that use of dual blockade may provide a new approach to prevention of diabetic nephropathy in patients with type 2 diabetes , hypertension and microalbuminuria Background : Although heart failure with a preserved or normal ejection fraction ( HFNEF or diastolic heart failure ) is common , treatment outcomes on quality of life and cardiac function are lacking . The effect of renin – angiotensin blockade by irbesartan or ramipril in combination with diuretics on quality of life ( QoL ) , regional and global systolic and diastolic function was assessed in HFNEF patients . Methods : 150 patients with HFNEF ( LVEF > 45 % ) were r and omised to ( 1 )  diuretics alone , ( 2 ) diuretics plus irbesartan , or ( 3 ) diuretics plus ramipril .  QoL , 6-minute walk test ( 6MWT ) and Doppler echocardiography were performed at baseline , 12 , 24 and 52 weeks . Results : The QoL score improved similarly in all three groups by 52 weeks ( −46 % , 51 % , and 50 % respectively , all p<0.01 ) , although 6MWT increased only slightly ( average + 3–6 % ) . Recurrent hospitalisation rates were equal in all groups ( 10–12 % in 1 year ) . At 1 year , LV dimensions or LVEF had not changed in any group , though both systolic and diastolic blood pressures were lowered in all three groups from 4 weeks onwards . At baseline both mean peak systolic ( Sm ) and early diastolic ( Em ) mitral annulus velocities were reduced , and increased slightly in the diuretic plus irbesartan ( Sm 4.5 ( SEM 0.17 ) to 4.9 ( SEM 0.16 ) cm/sec ; Em 3.8 ( SEM 0.25 ) to 4.2 ( SEM 0.25 ) cm/sec ) and ramipril ( Sm 4.5 ( SEM 0.24 ) to 4.9 ( SEM 0.20 ) cm/sec ; Em 3.3 ( SEM 0.25 ) to 4.04 ( SEM 0.32 ) cm/sec ) groups ( both p<0.05 ) . NT-pro-BNP levels were raised at baseline ( 595 ( SD 905 ) pg/ml ; range 5–4748 ) and fell in the irbesartan ( −124 ( SD 302 ) pg/ml , p = 0.01 ) and ramipril ( −173 ( SD 415 ) pg/ml , p = 0.03 ) groups only . Conclusions : In this typically elderly group 
    Output:
    