You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Randomized Trial of Acupuncture to Lower Blood Pressure
Abstract 1:
Background — Arterial hypertension is a prime cause of morbidity and mortality in the general population . Pharmacological treatment has limitations result ing from drug side effects , costs , and patient compliance . Thus , we investigated whether traditional Chinese medicine acupuncture is able to lower blood pressure . Methods and Results — We r and omized 160 out patients ( age , 58±8 years ; 78 men ) with uncomplicated arterial hypertension in a single-blind fashion to a 6-week course of active acupuncture or sham acupuncture ( 22 sessions of 30 minutes ' duration ) . Seventy-eight percent were receiving antihypertensive medication , which remained unchanged . Primary outcome parameters were mean 24-hour ambulatory blood pressure levels after the treatment course and 3 and 6 months later . One hundred forty patients finished the treatment course ( 72 with active treatment , 68 with sham treatment ) . There was a significant ( P<0.001 ) difference in posttreatment blood pressures adjusted for baseline values between the active and sham acupuncture groups at the end of treatment . For the primary outcome , the difference between treatment groups amounted to 6.4 mm Hg ( 95 % CI , 3.5 to 9.2 ) and 3.7 mm Hg ( 95 % CI , 1.6 to 5.8 ) for 24-hour systolic and diastolic blood pressures , respectively . In the active acupuncture  group , mean 24-hour ambulatory systolic and diastolic blood pressures decreased significantly after treatment by 5.4 mm Hg ( 95 % CI , 3.2 to 7.6 ) and 3.0 mm Hg ( 95 % CI , 1.5 to 4.6 ) , respectively . At 3 and 6 months , mean systolic and diastolic blood pressures returned to pretreatment levels in the active treatment group . Conclusions — Acupuncture according to traditional Chinese medicine , but not sham acupuncture , after 6 weeks of treatment significantly lowered mean 24-hour ambulatory blood pressures ; the effect disappeared after cessation of acupuncture treatment


Title 2:
Stop Hypertension With the Acupuncture Research Program (SHARP): Results of a Randomized, Controlled Clinical Trial
Abstract 2:
Case studies and small trials suggest that acupuncture may effectively treat hypertension , but no large r and omized trials have been reported . The Stop Hypertension with the Acupuncture Research Program pilot trial enrolled 192 participants with untreated blood pressure ( BP ) in the range of 140/90 to 179/109 mm Hg . The design of the trial combined rigorous methodology and adherence to principles of traditional Chinese medicine . Participants were weaned off  antihypertensives  before enrollment and were then r and omly assigned to 3 treatments : individualized traditional Chinese acupuncture , st and ardized acupuncture at preselected points , or invasive sham acupuncture .  Participants received ≤12  acupuncture treatments over 6 to 8 weeks . During the first 10 weeks after r and om assignment , BP was monitored every 14 days , and antihypertensives were prescribed if BP exceeded 180/110 mm Hg . The mean BP decrease from baseline to 10 weeks , the primary end point , did not differ significantly between participants r and omly assigned to active ( individualized and st and ardized ) versus sham acupuncture  ( systolic BP : −3.56 versus −3.84 mm Hg , respectively ; 95 % CI for the difference : −4.0 to 4.6 mm Hg ; P=0.90 ; diastolic BP : −4.32 versus −2.81 mm Hg , 95 % CI for the difference : −3.6 to 0.6 mm Hg ; P=0.16 ) . Categorizing participants by age , race , gender , baseline BP , history of antihypertensive use , obesity , or primary traditional Chinese medicine diagnosis did not reveal any subgroups for which the benefits of active acupuncture differed significantly from sham acupuncture . Active acupuncture provided no greater benefit than invasive sham acupuncture  in reducing systolic or diastolic BP


Title 3:
Acupuncture, a promising adjunctive therapy for essential hypertension: a double-blind, randomized, controlled trial
Abstract 3:
Abstract Background : This study assessed effects of acupuncture as an add-on to conventional antihypertensive managements such as medication or lifestyle modification for hypertensive or pre-hypertensive subjects . Methods : A r and omized , double-blind , placebo-controlled trial was conducted at Kyung Hee University Hospital . Forty-one hypertensive or pre-hypertensive ( systolic BP≥120 mmHg or diastolic BP≥80 mmHg ) volunteers were recruited and r and omly assigned into real or sham acupuncture groups . The hypertensive subjects on antihypertensive medication continued their medication . Acupuncture point prescriptions were partially individualized , based on the Saam acupuncture theory . Park 's sham needle method was adopted for the sham procedure . Measurements were performed at baseline , weeks 4 and 8 . BP , scales of overall health and pain , and anticipation or satisfaction for the treatments , were recorded . Results : Thirty subjects completed the intervention , all of whom were on antihypertensive medication . The sham acupuncture group showed no significant change in mean BP , while the real acupuncture group showed a significant ( p<0.01 ) decrease in mean BP after 8 weeks of intervention from 136.8/83.7 to 122.1/76.8 mmHg . Other factors showed no difference between the groups throughout the study . Conclusion : Acupuncture seems to offer an additional benefit to the treatment of hypertensive patients


Title 4:
Do certain countries produce only positive results? A systematic review of controlled trials.
Abstract 4:
OBJECTIVE To determine whether clinical trials originating in certain countries always have positive results . DATA SOURCES Abstract s of trials from Medline ( January 1966-June 1995 ) . STUDY SELECTION Two separate studies were conducted . The first included trials in which the clinical outcome of a group of subjects receiving acupuncture  was compared to that of a group receiving placebo , no treatment , or a nonacupuncture intervention . In the second study , r and omized or controlled trials of interventions other than  acupuncture  that were published in China , Japan , Russia/USSR , or Taiwan were compared to those published in Engl and . DATA EXTRACTION Blinded review ers determined inclusion and outcome and separately classified each trial by country of origin . DATA SYNTHESIS In the study of acupuncture  trials , 252 of 1085 abstract s met the inclusion criteria . Research conducted in certain countries was uniformly favorable to acupuncture ; all trials originating in China , Japan , Hong Kong , and Taiwan were positive , as were 10 out of 11 of those published in Russia/USSR . In studies that examined interventions other than acupuncture , 405 of 1100 abstract s met the inclusion criteria . Of trials published in Engl and , 75 % gave the test treatment as superior to control . The results for China , Japan , Russia/USSR , and Taiwan were 99 % , 89 % , 97 % , and 95 % , respectively . No trial published in China or Russia/USSR found a test treatment to be ineffective . CONCLUSIONS Some countries publish unusually high proportions of positive results . Publication bias is a possible explanation . Research ers undertaking systematic review s should consider carefully how to manage data from these countries


Title 5:
[Effect of a standardized acupuncture treatment on complains, blood pressure and serum lipids of hypertensive, postmenopausal women. A randomized, controlled clinical study].
Abstract 5:
BACKGROUND Acupuncture according to the Chinese syndrome is often used in patients with postmenopausal complaints . Often these patients have an increased blood pressure . As experienced therapists report that acupuncture is efficient also in hypertension , our aim was to investigate whether the acupuncture used for the treatment of postmenopausal syndrome also has an effect on blood pressure . PATIENTS AND METHODS The efficacy of a st and ardized acupuncture according to the Chinese syndrome was evaluated in a r and omized , single-blind , placebo-controlled cross-over study with 10 postmenopausal patients with mild hypertension .  Blood pressure was measured by 24-hour ambulatory blood pressure measurement . Complaints and well-being were evaluated by vali date d question naires . In addition , serum lipids and excretion of catecholamines in the 24-hour urine were measured . RESULTS Blood pressure was altered neither by verum nor placebo acupuncture , however , complaints were significantly reduced and well-being was improved after verum treatment . The improvement lasted less than two months . Serum lipids did not change , but the excretion of normetanephrine was reduced by verum acupuncture . CONCLUSIONS Acupuncture with a st and ardized combination of acupuncture points according to the Chinese syndrome can transitorily reduce postmenopausal complaints , but does not alter blood pressure or serum lipids at the same time


Title 6:
Use of complementary and alternative medical therapies in patients with cardiovascular disease.
Abstract 6:
BACKGROUND Complementary and alternative medical ( CAM ) therapies are becoming increasingly popular , yet little information is available about the prevalence and patterns of CAM therapy use by patients with cardiovascular disease ( CVD ) . METHODS Interviewers administered telephone question naires to 107 patients r and omly selected from a stratified cohort of 2487 eligible patients participating in a registry of patients with CVD . RESULTS The current use of CAM therapies was reported by 64 % of the patients surveyed . Nutritional supplements ( 40 % ) and megadose vitamins ( 35 % ) were the most frequently used preparations . Most CAM therapy users ( 65 % ) cited their underlying cardiac condition as the reason for taking such therapy . The most common sources of information about CAM were a friend or relative ( 43 % ) or the respondent 's usual physician . However , although 80 % of respondents cl aim ed that they had discussed their use of CAM therapies  with their physician , 58 % of respondents taking a potentially toxic cardiovascular medication ( digoxin , warfarin , sotalol , or amiodarone ) were simultaneously taking an oral supplement . CONCLUSION The use of CAM therapies was high in the cohort of patients surveyed . Physicians caring for patients with CVD need to inquire about CAM therapy use . Further scientific study should be performed to evaluate the potential benefits and risks of CAM therapies in this patient population


Title 7:
Factors associated with noncompliance of patients taking antihypertensive medications.
Abstract 7:
Poor adherence to drug therapy decreases the effectiveness of antihypertensive treatment . Patients must take more than 80 % of their antihypertensive drugs to maintain adequate blood pressure control . To underst and the incidence of noncompliance and contributing factors , a pilot study was conducted in which a question naire was devised and administered to a r and om sample of 243 hypertensive patients of the adult ambulatory care clinic at Method ist Hospital of Indiana . Ninety-eight patients completed the telephone survey .  Demographic data were obtained through chart review s. The results indicated that 30 - 46 % of the patients were noncompliant with their antihypertensive drug regimens . Factors found to be associated with noncompliance were ; employment ( P = .0077 ) , use of home remedies ( P = .0043 ) , age ( P = .0165 ) , experience of side effects ( P = .0051 ) , level of concern with missed doses ( P = .0043 ) , and cost ( P = .014 ) . The incidence of noncompliance in this pilot sample is lower than the estimated 50 % noncompliance rate of published data . More research is needed to underst and the determinants of noncompliance in order to design interventions to improve compliance
Considering the limitation of the four positive noninferiority studies and the results of the meta- analysis of the three sham-controlled studies , the notion that acupuncture may lower high BP is inconclusive .