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: In order to assess the effects of a Behavioral Treatment Program in the control of primary hypertension , twenty one unmedicated hypertensives were r and omly allocated to three groups : first , a treatment group ( BHG ) receiving a Behavioral Treatment which included : deep muscle relaxation , peripheral temperature Biofeedback and anxiety management training ; second , the placebo attention control group ( PHG ) and third , a control group of hypertensives too ( CHG ) . Additionally , were compared with seven normotensives subjects ( CNG ) . The post-treatment measures showed a significant reduction ( p < 0.001 ) in systolic and diastolic values only in the ( BHG ) . In a six months follow-up the ( BHG ) group still showed a significant reduction in the systolic and diastolic BP ( p < 0.02 ; p < 0.01 ) . Moreover individual variations in response to treatment were observed in this group , ( BHG ) CONTEXT The long-term risk for developing hypertension is best described by the lifetime risk statistic . The lifetime risk for hypertension and trends in this risk over time are unknown . OBJECTIVES To estimate the residual lifetime risk for hypertension in older US adults and to evaluate temporal trends in this risk . DESIGN , SETTING , AND PARTICIPANTS  Community-based prospect i ve cohort study of 1298 participants from the Framingham Heart Study who were aged 55 to 65 years and free of hypertension at baseline ( 1976 - 1998 ) . MAIN OUTCOME MEASURES Residual lifetime risk ( lifetime cumulative incidence not adjusted for competing causes of mortality ) for hypertension , defined as blood pressure of 140/90 mm Hg or greater or use of antihypertensive medications . RESULTS The residual lifetime risks for developing hypertension and stage 1 high blood pressure or higher ( greater-than-or-equal to 140/90 mm Hg regardless of treatment ) were 90 % in both 55- and 65-year-old participants . The lifetime probability of receiving antihypertensive medication was 60 % . The risk for hypertension remained unchanged for women , but it was approximately 60 % higher for men in the contemporary 1976 - 1998 period compared with an earlier 1952 - 1975 period . In contrast , the residual lifetime risk for stage 2 high blood pressure or higher ( greater-than-or-equal to 160/100 mm Hg regardless of treatment ) was considerably lower in both sexes in the recent period ( 35%-57 % in 1952 - 1975 vs 35%-44 % in 1976 - 1998 ) , likely due to a marked increase in treatment of individuals with substantially elevated blood pressure . CONCLUSION The residual lifetime risk for hypertension for middle-aged and elderly individuals is 90 % , indicating a huge public health burden . Although the decline in lifetime risk for stage 2 high blood pressure or higher represents a major achievement , efforts should be directed at the primary prevention of hypertension & NA ; We determined the effect of relaxation therapy for hypertension in patients whose blood pressure remained elevated despite the use of antihypertensive medication . The effect was assessed in multiple setting s , including the relaxation therapist 's office , the Hypertension Clinic , and the patient 's natural environment , the latter using 24‐hour automated ambulatory blood pressure measures . Nineteen patients were r and omized  either to temperature biofeedback‐assisted relaxation or to an attention control , “ stress education . ” Antihypertensive medication was kept constant . In the behavioral therapist 's office , blood pressure decreased in equivalent amounts with both treatments . Hypertension Clinic nurse blood pressure remained stable or increased with both treatments , but again there was no difference between treatments . Ambulatory blood pressure increased with relaxation therapy and decreased with stress education , the effect being significant for diastolic pressure . The effects on ambulatory blood pressure were limited to the waking hours . The only variable that showed superior effects for relaxation therapy was physician‐determined blood pressure . These results call into question the generalizability of the effects of relaxation therapy from one setting to another & NA ; To examine how various aspects of attentional functioning are affected by autonomic self‐regulation procedures , this study compared the effect of two treatment programs ( EMG and thermal biofeedback used in conjunction with various somatic and cognitive relaxation/self‐regulation strategies , and Benson 's Relaxation Response procedure ) and a Waiting List control group for essential hypertensive adults on three , perhaps overlapping , attentional dimensions : the capacity to disembed figure from ground ( Embedded Figures Test , Block Design , and Picture Completion WAIS subtests ) ; the capacity to voluntarily deploy attention ( Digit Span subtest of the WAIS ) , and capacity to sustain attention or become absorbed ( as measured by the Tellegen Absorption Scale ) . Thirty essential hypertensive men and women were r and omly placed in one of the three groups . Attentional dimensions were assessed before and after the 10‐week treatment program ( or waiting period ) and the relationship between blood pressure and attentional changes were assessed . The only group to evidence significant blood pressure reduction , the “ Biofeedback Group , ” became significantly more Field Independent as measured by the EFT ( p less than 0.001 ) and the Block Design measure ( p less than 0.01 ) and evidence d a strong trend in the same direction on the Picture Completion measure ( p less than 0.052 , NS ) . No other significant pre‐post attentional changes were found . A Pearson product correlation revealed that changes in diastolic blood pressure were significantly correlated with changes in EFT ( r = 0.54 , p less than 0.0001 ) and the Picture Completion measure ( r = 0.32 , p less than 0.05 ) . The cognitive effect of autonomic self‐regulation is discussed . In addition , the possible role of attention in autonomic self‐regulation is examined & NA ; The efficacy and the mechanisms of action of two behavioral treatments for essential hypertension were compared : cognitive group therapy for anger control and biofeedback for heart rate control . The cognitive therapy aim ed at lowering the “ general anger ” level and helping overt expression of “ anger out ; ” heart rate biofeedback aim ed at slowing heart rate in stress situations . Ninety‐seven essential hypertensive patients were r and omly assigned to three groups ; after 20 dropouts , 77 patients fully participated in the study : cognitive treatment ( N = 30 ) , biofeedback ( N = 27 ) , and control ( no treatment , N = 20 ) . The treatments were held in 17 weekly sessions ; during treatment , blood pressure was measured once a month , and during follow‐up after 1 and 6 months . The anger level and heart rate control were assessed at the beginning and the end of treatment . The main results were : 1 ) a significant decrease of blood pressure for both treatments as compared with control , 2 ) a significant decrease of blood pressure with heart rate biofeedback as compared with cognitive therapy , and 3 ) a better control in anger achieved with cognitive therapy and a lesser control in heart rate as compared with biofeedback Thirty-three moderate hypertensives were converted to a 2-drug regimen of metoprolol and diuretic and BPs stabilized at a well-controlled level . They then completed one of three conditions over an 8-week interval : ( I ) 16 sessions of TBF ( h and and foot warming ) ; ( II ) 16 sessions of frontal EMG-BF ; ( III ) regular home monitoring of BP . Attempts were then made to withdraw the patients from the sympatholytic medication . Those successfully withdrawn were followed up for one year . There were no significant advantages for TBF over the other two conditions in the short term or with long-term follow-up . Only 27 % of treated patients ( including Condition III failures who were remedicated and treated with TBF ) were successfully off of the sympatholytic at a one-year follow-up . The generally poor results on clinical outcome were confirmed by clinic BPs , home BPs by patients , and 24-hour ambulatory BPs We have conducted a cross-cultural ( USA and USSR ) comparison of thermal biofeedback ( TBF ) and autogenic training ( AT ) to a self-relaxation control condition in 59 unmedicated males with mild hypertension . Identical assessment and treatment protocol s were carried out in both setting s ( Albany , New York , and Moscow ) . Treatments were delivered in small groups on an outpatient basis twice per week for 10 weeks . Results showed comparable , significant ( p less than .05 ) , short-term decreases ( M = 8.5 mm Hg ) in diastolic blood pressure ( DBP ) for both treatments at both sites . However , the Soviet patients , starting with significantly ( p less than .01 ) higher systolic blood pressures ( SBPs ) , showed significant decreases ( M = 12.8 mm Hg ) in SBP , whereas the American patients did not change appreciably ( M = 4.6 mm Hg ) . During follow-up , the treated Soviet patients showed significantly ( p less than .05 ) better maintenance of treatment effects , from 3 months to 1 year , than did the American patients . At 1 year , 75 % of the treated Soviet patients had DBPs less than 90 mm Hg , whereas only 24 % of the American patients had comparable DBPs & NA ; This industry‐based r and omized study compared the effects of behavioral treatment ( BT ) and blood pressure monitoring ( BPM ) on blood pressure ( BP ) change in 158 unmedicated persons with mild hypertension ( diastolic blood pressure 90 to 104 mm Hg ) . Participants recruited by a three‐stage screening were r and omly assigned to BT or BPM groups and stratified by entry diastolic blood pressure ( DBP ) , age , and sex . BT participants received relaxation training , with or without the addition of biofeedback , cognitive restructuring , and health behavior change components . During the study , all participants were followed by their usual care physicians and received medical advice . At 18 weeks into the study , after the BT groups completed training , both the BT and BPM groups showed significant reductions in systolic blood pressure ( SBP ) and DBP assessed in the company medical clinic ( 7.4 and 9.0 mm Hg SBP and 4.5 and 5.9 mm Hg DBP , respectively ) . These reductions were maintained throughout the 36‐week follow‐up period . Reductions in BP assessed at the participants ' worksite were similar for BT and BPM participants throughout most of the trial , indicating little advantage to the inclusion of behavioral interventions over monitoring alone . Differences in BP changes observed among participants receiving various combinations of behavioral treatment components indicated that the cognitive restructuring component reduced SBP in the worksite by an additional 5.4 mm Hg ( p less than 0.05 ) . Possible explanations for the BP changes observed in the BPM group and implication s of the results for the treatment of unmedicated mild hypertensives are discussed Few studies of psychological interventions for essential hypertension have incorporated comprehensive coping skills treatment programs , evaluated the efficacy of such programs against credible , minimally effective controls , examined the effects of these interventions on pressor responses , or clarified the nature of person by treatment interactions . The present study examined the relative effectiveness of multimodal stress management training and a minimally effective treatment control ( i.e. GSR biofeedback training ) in the treatment of essential hypertensives ' blood pressure at rest and in response to simulated stressful interpersonal situations . At the conclusion of an 8 week training period , stress management participants exhibited reliably lower resting diastolic blood pressure and tended to exhibit lower systolic pressure than controls . The former condition maintained their lower pressures through a 6-month follow-up period , but decreases in controls over follow-up rendered the conditions equivalent in blood pressure . No differences between conditions emerged in analyses on pressor responses .  Stress management training was somewhat more effective for individuals scoring low rather than high on measures of trait anxiety and irritability OBJECTIVE This r and omized controlled study examined whether a 4-week blood pressure ( BP ) biofeedback program can reduce BP and BP reactivity to stress in participants with mild hypertension . METHODS Participants in the active biofeedback group ( n=20 ) were trained in 4 weekly laboratory sessions to self-regulate their BP with continuous BP feedback signals , whereas participants in the sham biofeedback group ( n=18 ) were told to manipulate their BP without feedback signals . BP , skin temperature , skin conductance , BP reactivity to stress , body weight , and state anxiety were assessed before training and repeated at the eighth week after the training . RESULTS The decreases in systolic ( 12.6 + /- 8.8 versus 4.1 + /- 5.7 ) and mean BP ( 8.2 + /- 6.9 versus 3.3 + /- 4.9 ) from baseline at week 12 follow-up were significantly greater in the active biofeedback group compared with the sham biofeedback group ( p=0.001 and 0.017 , respectively ) . Results from analysis of covariance with the follow-up systolic blood pressure ( SBP ) ( or mean arterial pressure [ MAP ] ) as the dependent variable , baseline SBP ( or MAP ) as the covariate , and group as the independent variable showed that biofeedback training effectively lowered SBP and MAP ( p=0.013 and 0.026 , respectively ) . The pre-to-post differences in skin conductance and SBP reactivity were statistically significant for the biofeedback group ( p=0.005 and 0.01 , respectively ) , but not for the control group . For the sample as a whole and for the biofeedback group , the state anxiety score and body weight remained unchanged . CONCLUSIONS BP biofeedback exerts a specific treatment effect in reducing BP  in individuals with mild hypertension , possibly through reducing pressor reactivity to stress The objective of this study was to evaluate the long term effect of a program of biofeedback-assisted relaxation on hypertensive patients by mental stress test reactivity 
    Output:
    
agent
***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: In order to assess the effects of a Behavioral Treatment Program in the control of primary hypertension , twenty one unmedicated hypertensives were r and omly allocated to three groups : first , a treatment group ( BHG ) receiving a Behavioral Treatment which included : deep muscle relaxation , peripheral temperature Biofeedback and anxiety management training ; second , the placebo attention control group ( PHG ) and third , a control group of hypertensives too ( CHG ) . Additionally , were compared with seven normotensives subjects ( CNG ) . The post-treatment measures showed a significant reduction ( p < 0.001 ) in systolic and diastolic values only in the ( BHG ) . In a six months follow-up the ( BHG ) group still showed a significant reduction in the systolic and diastolic BP ( p < 0.02 ; p < 0.01 ) . Moreover individual variations in response to treatment were observed in this group , ( BHG ) CONTEXT The long-term risk for developing hypertension is best described by the lifetime risk statistic . The lifetime risk for hypertension and trends in this risk over time are unknown . OBJECTIVES To estimate the residual lifetime risk for hypertension in older US adults and to evaluate temporal trends in this risk . DESIGN , SETTING , AND PARTICIPANTS  Community-based prospect i ve cohort study of 1298 participants from the Framingham Heart Study who were aged 55 to 65 years and free of hypertension at baseline ( 1976 - 1998 ) . MAIN OUTCOME MEASURES Residual lifetime risk ( lifetime cumulative incidence not adjusted for competing causes of mortality ) for hypertension , defined as blood pressure of 140/90 mm Hg or greater or use of antihypertensive medications . RESULTS The residual lifetime risks for developing hypertension and stage 1 high blood pressure or higher ( greater-than-or-equal to 140/90 mm Hg regardless of treatment ) were 90 % in both 55- and 65-year-old participants . The lifetime probability of receiving antihypertensive medication was 60 % . The risk for hypertension remained unchanged for women , but it was approximately 60 % higher for men in the contemporary 1976 - 1998 period compared with an earlier 1952 - 1975 period . In contrast , the residual lifetime risk for stage 2 high blood pressure or higher ( greater-than-or-equal to 160/100 mm Hg regardless of treatment ) was considerably lower in both sexes in the recent period ( 35%-57 % in 1952 - 1975 vs 35%-44 % in 1976 - 1998 ) , likely due to a marked increase in treatment of individuals with substantially elevated blood pressure . CONCLUSION The residual lifetime risk for hypertension for middle-aged and elderly individuals is 90 % , indicating a huge public health burden . Although the decline in lifetime risk for stage 2 high blood pressure or higher represents a major achievement , efforts should be directed at the primary prevention of hypertension & NA ; We determined the effect of relaxation therapy for hypertension in patients whose blood pressure remained elevated despite the use of antihypertensive medication . The effect was assessed in multiple setting s , including the relaxation therapist 's office , the Hypertension Clinic , and the patient 's natural environment , the latter using 24‐hour automated ambulatory blood pressure measures . Nineteen patients were r and omized  either to temperature biofeedback‐assisted relaxation or to an attention control , “ stress education . ” Antihypertensive medication was kept constant . In the behavioral therapist 's office , blood pressure decreased in equivalent amounts with both treatments . Hypertension Clinic nurse blood pressure remained stable or increased with both treatments , but again there was no difference between treatments . Ambulatory blood pressure increased with relaxation therapy and decreased with stress education , the effect being significant for diastolic pressure . The effects on ambulatory blood pressure were limited to the waking hours . The only variable that showed superior effects for relaxation therapy was physician‐determined blood pressure . These results call into question the generalizability of the effects of relaxation therapy from one setting to another & NA ; To examine how various aspects of attentional functioning are affected by autonomic self‐regulation procedures , this study compared the effect of two treatment programs ( EMG and thermal biofeedback used in conjunction with various somatic and cognitive relaxation/self‐regulation strategies , and Benson 's Relaxation Response procedure ) and a Waiting List control group for essential hypertensive adults on three , perhaps overlapping , attentional dimensions : the capacity to disembed figure from ground ( Embedded Figures Test , Block Design , and Picture Completion WAIS subtests ) ; the capacity to voluntarily deploy attention ( Digit Span subtest of the WAIS ) , and capacity to sustain attention or become absorbed ( as measured by the Tellegen Absorption Scale ) . Thirty essential hypertensive men and women were r and omly placed in one of the three groups . Attentional dimensions were assessed before and after the 10‐week treatment program ( or waiting period ) and the relationship between blood pressure and attentional changes were assessed . The only group to evidence significant blood pressure reduction , the “ Biofeedback Group , ” became significantly more Field Independent as measured by the EFT ( p less than 0.001 ) and the Block Design measure ( p less than 0.01 ) and evidence d a strong trend in the same direction on the Picture Completion measure ( p less than 0.052 , NS ) . No other significant pre‐post attentional changes were found . A Pearson product correlation revealed that changes in diastolic blood pressure were significantly correlated with changes in EFT ( r = 0.54 , p less than 0.0001 ) and the Picture Completion measure ( r = 0.32 , p less than 0.05 ) . The cognitive effect of autonomic self‐regulation is discussed . In addition , the possible role of attention in autonomic self‐regulation is examined & NA ; The efficacy and the mechanisms of action of two behavioral treatments for essential hypertension were compared : cognitive group therapy for anger control and biofeedback for heart rate control . The cognitive therapy aim ed at lowering the “ general anger ” level and helping overt expression of “ anger out ; ” heart rate biofeedback aim ed at slowing heart rate in stress situations . Ninety‐seven essential hypertensive patients were r and omly assigned to three groups ; after 20 dropouts , 77 patients fully participated in the study : cognitive treatment ( N = 30 ) , biofeedback ( N = 27 ) , and control ( no treatment , N = 20 ) . The treatments were held in 17 weekly sessions ; during treatment , blood pressure was measured once a month , and during follow‐up after 1 and 6 months . The anger level and heart rate control were assessed at the beginning and the end of treatment . The main results were : 1 ) a significant decrease of blood pressure for both treatments as compared with control , 2 ) a significant decrease of blood pressure with heart rate biofeedback as compared with cognitive therapy , and 3 ) a better control in anger achieved with cognitive therapy and a lesser control in heart rate as compared with biofeedback Thirty-three moderate hypertensives were converted to a 2-drug regimen of metoprolol and diuretic and BPs stabilized at a well-controlled level . They then completed one of three conditions over an 8-week interval : ( I ) 16 sessions of TBF ( h and and foot warming ) ; ( II ) 16 sessions of frontal EMG-BF ; ( III ) regular home monitoring of BP . Attempts were then made to withdraw the patients from the sympatholytic medication . Those successfully withdrawn were followed up for one year . There were no significant advantages for TBF over the other two conditions in the short term or with long-term follow-up . Only 27 % of treated patients ( including Condition III failures who were remedicated and treated with TBF ) were successfully off of the sympatholytic at a one-year follow-up . The generally poor results on clinical outcome were confirmed by clinic BPs , home BPs by patients , and 24-hour ambulatory BPs We have conducted a cross-cultural ( USA and USSR ) comparison of thermal biofeedback ( TBF ) and autogenic training ( AT ) to a self-relaxation control condition in 59 unmedicated males with mild hypertension . Identical assessment and treatment protocol s were carried out in both setting s ( Albany , New York , and Moscow ) . Treatments were delivered in small groups on an outpatient basis twice per week for 10 weeks . Results showed comparable , significant ( p less than .05 ) , short-term decreases ( M = 8.5 mm Hg ) in diastolic blood pressure ( DBP ) for both treatments at both sites . However , the Soviet patients , starting with significantly ( p less than .01 ) higher systolic blood pressures ( SBPs ) , showed significant decreases ( M = 12.8 mm Hg ) in SBP , whereas the American patients did not change appreciably ( M = 4.6 mm Hg ) . During follow-up , the treated Soviet patients showed significantly ( p less than .05 ) better maintenance of treatment effects , from 3 months to 1 year , than did the American patients . At 1 year , 75 % of the treated Soviet patients had DBPs less than 90 mm Hg , whereas only 24 % of the American patients had comparable DBPs & NA ; This industry‐based r and omized study compared the effects of behavioral treatment ( BT ) and blood pressure monitoring ( BPM ) on blood pressure ( BP ) change in 158 unmedicated persons with mild hypertension ( diastolic blood pressure 90 to 104 mm Hg ) . Participants recruited by a three‐stage screening were r and omly assigned to BT or BPM groups and stratified by entry diastolic blood pressure ( DBP ) , age , and sex . BT participants received relaxation training , with or without the addition of biofeedback , cognitive restructuring , and health behavior change components . During the study , all participants were followed by their usual care physicians and received medical advice . At 18 weeks into the study , after the BT groups completed training , both the BT and BPM groups showed significant reductions in systolic blood pressure ( SBP ) and DBP assessed in the company medical clinic ( 7.4 and 9.0 mm Hg SBP and 4.5 and 5.9 mm Hg DBP , respectively ) . These reductions were maintained throughout the 36‐week follow‐up period . Reductions in BP assessed at the participants ' worksite were similar for BT and BPM participants throughout most of the trial , indicating little advantage to the inclusion of behavioral interventions over monitoring alone . Differences in BP changes observed among participants receiving various combinations of behavioral treatment components indicated that the cognitive restructuring component reduced SBP in the worksite by an additional 5.4 mm Hg ( p less than 0.05 ) . Possible explanations for the BP changes observed in the BPM group and implication s of the results for the treatment of unmedicated mild hypertensives are discussed Few studies of psychological interventions for essential hypertension have incorporated comprehensive coping skills treatment programs , evaluated the efficacy of such programs against credible , minimally effective controls , examined the effects of these interventions on pressor responses , or clarified the nature of person by treatment interactions . The present study examined the relative effectiveness of multimodal stress management training and a minimally effective treatment control ( i.e. GSR biofeedback training ) in the treatment of essential hypertensives ' blood pressure at rest and in response to simulated stressful interpersonal situations . At the conclusion of an 8 week training period , stress management participants exhibited reliably lower resting diastolic blood pressure and tended to exhibit lower systolic pressure than controls . The former condition maintained their lower pressures through a 6-month follow-up period , but decreases in controls over follow-up rendered the conditions equivalent in blood pressure . No differences between conditions emerged in analyses on pressor responses .  Stress management training was somewhat more effective for individuals scoring low rather than high on measures of trait anxiety and irritability OBJECTIVE This r and omized controlled study examined whether a 4-week blood pressure ( BP ) biofeedback program can reduce BP and BP reactivity to stress in participants with mild hypertension . METHODS Participants in the active biofeedback group ( n=20 ) were trained in 4 weekly laboratory sessions to self-regulate their BP with continuous BP feedback signals , whereas participants in the sham biofeedback group ( n=18 ) were told to manipulate their BP without feedback signals . BP , skin temperature , skin conductance , BP reactivity to stress , body weight , and state anxiety were assessed before training and repeated at the eighth week after the training . RESULTS The decreases in systolic ( 12.6 + /- 8.8 versus 4.1 + /- 5.7 ) and mean BP ( 8.2 + /- 6.9 versus 3.3 + /- 4.9 ) from baseline at week 12 follow-up were significantly greater in the active biofeedback group compared with the sham biofeedback group ( p=0.001 and 0.017 , respectively ) . Results from analysis of covariance with the follow-up systolic blood pressure ( SBP ) ( or mean arterial pressure [ MAP ] ) as the dependent variable , baseline SBP ( or MAP ) as the covariate , and group as the independent variable showed that biofeedback training effectively lowered SBP and MAP ( p=0.013 and 0.026 , respectively ) . The pre-to-post differences in skin conductance and SBP reactivity were statistically significant for the biofeedback group ( p=0.005 and 0.01 , respectively ) , but not for the control group . For the sample as a whole and for the biofeedback group , the state anxiety score and body weight remained unchanged . CONCLUSIONS BP biofeedback exerts a specific treatment effect in reducing BP  in individuals with mild hypertension , possibly through reducing pressor reactivity to stress The objective of this study was to evaluate the long term effect of a program of biofeedback-assisted relaxation on hypertensive patients by mental stress test reactivity 
    Output:
    