{
  "schema_version": "chamgap-public-evidence-check-1.0",
  "public_id": "v2990-s0",
  "verdict_number": "2990",
  "title": "High-resistance IMST × six-week resting systolic blood pressure: evidence gaps",
  "view_version": "1.0",
  "view_created_date": "2026-10-16",
  "criteria_version": "1.0",
  "criteria_date": "2026-10-06",
  "review_date": null,
  "legacy_evidence_date": "2026-09-07",
  "review_scope": {
    "materials_read": "Existing review summaries and stored records of methodological application",
    "clinical_papers_directly_read": false,
    "new_clinical_search": false,
    "limitation": "Existing stored summary and preserved methodology application records. External papers, abstracts, registration, protocols, SAPs, original result tables and support disclosures are unread, and review of existing content remains incomplete.",
    "date_meaning": "This is the date the stored materials were checked, not the date of a new search of the clinical literature."
  },
  "claim_context": {
    "population": "Middle-aged and older adults aged 50–79 with above-normal pressure. The original records 38 randomized, 36 analyzed and 18 analyzed per arm. Exact eligibility, baseline medication, disease, endpoint denominators and missingness are unverified. Allocation and analysis counts are not added as separate people.",
    "intervention": "High-resistance inspiratory muscle strength training (IMST) in the original study. This identifies preserved exposure without personal procedures, device settings, treatment decisions or medication-replacement advice. Actual exposure, adherence and concurrent-care details are unverified.",
    "dose": "Original six days weekly, 30 breaths daily, six weeks, 55% maximal inspiratory pressure in week 1, 65% in week 2, 75% thereafter and five sets of six breaths are preserved only to identify the study. No new total-exposure, frequency or individual-resistance calculations or training instructions are created.",
    "comparator": "Low-resistance 15% sham. This is not no intervention, no breathing training or a direct medication comparison. Actual control exposure, masking, sensations/attention, concurrent care and direct-contrast details are unverified.",
    "endpoint": "The selected endpoint is six-week resting SBP. Original 135±2 to 126±3 versus 134±2 to 131±3 mmHg and group-by-time P=.02 are retained. Definition of ±, exact adjusted between-group effect and 95% CI are unverified. DBP P=.17, ambulatory SBP P=.07, approximately 45% relative FMD change and unmeasured cardiovascular events are distinguished.",
    "duration": "Short-term results after six weeks of training and pressure measurement. Post-training persistence, actual long-term follow-up, rare harms, cardiovascular events and medication-replacement effects are unverified. Follow-up details, sustained effects and long-term safety are not newly filled.",
    "excluded_extensions": [
      "Certifying the 9 mmHg within-arm fall, 6 mmHg crude difference or P=.02 as an adjusted between-group effect, 95% CI or clinical importance",
      "Transferring resting-SBP signals to equivalent DBP/ambulatory or 24-hour-pressure effects, FMD percentage points or cardiovascular-event prevention",
      "Converting null DBP, ambulatory P=.07 and unmeasured events together into zero effects, equivalence or safety",
      "Adding 38 randomized, 36 analyzed, 18 per arm, multiple endpoints or two subclaim sheets as new independent trials, participants or replications",
      "Inheriting parent C54, Caution, axes or historical checks as subclaim scores, current clinical review or independence certification",
      "Creating new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training, medication changes or treatment-replacement instructions"
    ]
  },
  "requirements": [
    {
      "item_id": "N01",
      "question_type": "Evidence condition",
      "question": "Which resting systolic-pressure claim is examined?",
      "needed": "Selected lower resting systolic-pressure claim",
      "role": "Required",
      "role_reason": "This condition connects Selected lower resting systolic-pressure claim with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Selected lower resting systolic-pressure claim must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: The selected SBP definition, population, time, comparator, original denominators and content review are needed. Absent subclaim fields are not filled with parent scores or axes. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The selected subclaim's original grade is C; its note records group-by-time P=.02 and an unverified adjusted between-group CI. Subclaim score, status and axes are absent and distinguished from parent C54, Caution and axes.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "The selected SBP definition, population, time, comparator, original denominators and content review are needed. Absent subclaim fields are not filled with parent scores or axes.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "The selected SBP definition, population, time, comparator, original denominators and content review are needed. Absent subclaim fields are not filled with parent scores or axes."
    },
    {
      "item_id": "N02",
      "question_type": "Evidence condition",
      "question": "What are the original six-week resting-pressure values?",
      "needed": "Baseline and six-week resting SBP by arm",
      "role": "Required",
      "role_reason": "This condition connects Baseline and six-week resting SBP by arm with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Baseline and six-week resting SBP by arm must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Analysis denominators, baseline/follow-up values, measurement conditions, model, definition of ±, adjusted between-group estimate and 95% CI are needed. No new differences or CIs were calculated. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "High-resistance IMST was 135±2 to 126±3 and low-resistance sham 134±2 to 131±3 mmHg, with group-by-time P=.02. The statistical definition of ± and exact adjusted between-group effect/CI are separately unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Analysis denominators, baseline/follow-up values, measurement conditions, model, definition of ±, adjusted between-group estimate and 95% CI are needed. No new differences or CIs were calculated.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Analysis denominators, baseline/follow-up values, measurement conditions, model, definition of ±, adjusted between-group estimate and 95% CI are needed. No new differences or CIs were calculated."
    },
    {
      "item_id": "N03",
      "question_type": "Evidence condition",
      "question": "Are 9 mmHg and 6 mmHg adjusted between-group effects?",
      "needed": "Within-arm fall, crude difference in changes and adjusted effect",
      "role": "Required",
      "role_reason": "This condition connects Within-arm fall, crude difference in changes and adjusted effect with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Within-arm fall, crude difference in changes and adjusted effect must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: The effect of interest, model, adjustment variables, exact estimate, CI and original result table are needed. The crude difference is not promoted to independent confirmation of efficacy. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original distinguishes the high-resistance arm's 9 mmHg within-arm fall, a 6 mmHg crude difference in changes after subtracting sham, and an adjusted between-group effect. These two numbers are existing statements, not recalculated or converted into adjusted effects/CIs.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "The effect of interest, model, adjustment variables, exact estimate, CI and original result table are needed. The crude difference is not promoted to independent confirmation of efficacy.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "The effect of interest, model, adjustment variables, exact estimate, CI and original result table are needed. The crude difference is not promoted to independent confirmation of efficacy."
    },
    {
      "item_id": "N04",
      "question_type": "Evidence condition",
      "question": "Does group-by-time P=.02 provide an exact effect and CI?",
      "needed": "Distinguishing tests, effect estimates and precision",
      "role": "Required",
      "role_reason": "This condition connects Distinguishing tests, effect estimates and precision with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Distinguishing tests, effect estimates and precision must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: The test model, interaction/direct contrast, adjusted estimate, CI, prespecified importance threshold and original denominators are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The resting-SBP group-by-time test is recorded as positive. P=.02 alone does not establish the exact adjusted between-group effect, 95% CI, direct contrast at an individual time point or clinical importance.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "The test model, interaction/direct contrast, adjusted estimate, CI, prespecified importance threshold and original denominators are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "The test model, interaction/direct contrast, adjusted estimate, CI, prespecified importance threshold and original denominators are needed."
    },
    {
      "item_id": "N05",
      "question_type": "Evidence condition",
      "question": "Is diastolic P=.17 the same result?",
      "needed": "Separate resting SBP and DBP endpoints",
      "role": "Required",
      "role_reason": "This condition connects Separate resting SBP and DBP endpoints with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Separate resting SBP and DBP endpoints must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: DBP measurement conditions, original arm values, denominators, effects, CIs, prespecified hierarchy and original analysis tables are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The stored summary separately records DBP interaction P=.17. Resting SBP P=.02 is not transferred to DBP success, and the null DBP finding is not converted into absence of all blood-pressure effects.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "DBP measurement conditions, original arm values, denominators, effects, CIs, prespecified hierarchy and original analysis tables are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "DBP measurement conditions, original arm values, denominators, effects, CIs, prespecified hierarchy and original analysis tables are needed."
    },
    {
      "item_id": "N06",
      "question_type": "Evidence condition",
      "question": "Are ambulatory and 24-hour pressure equally established?",
      "needed": "Resting versus ambulatory measurement conditions",
      "role": "Required",
      "role_reason": "This condition connects Resting versus ambulatory measurement conditions with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Resting versus ambulatory measurement conditions must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Ambulatory measurement/valid time, 24-hour/day-night definitions, denominators, between-group values, CIs and detailed DBP tables are needed. P=.07 does not establish zero effect or equivalence. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original records ambulatory SBP interaction P=.07 and states that DBP/24-hour pressure were not equally established. Resting-SBP values and P values are not copied to ambulatory, 24-hour, daytime or nighttime values.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Ambulatory measurement/valid time, 24-hour/day-night definitions, denominators, between-group values, CIs and detailed DBP tables are needed. P=.07 does not establish zero effect or equivalence.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Ambulatory measurement/valid time, 24-hour/day-night definitions, denominators, between-group values, CIs and detailed DBP tables are needed. P=.07 does not establish zero effect or equivalence."
    },
    {
      "item_id": "N07",
      "question_type": "Evidence condition",
      "question": "Was the actual control low-resistance sham?",
      "needed": "High resistance versus 15% low-resistance sham",
      "role": "Required",
      "role_reason": "This condition connects High resistance versus 15% low-resistance sham with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for High resistance versus 15% low-resistance sham must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Actual resistance/exposure, device, masking, concurrent care, denominators and direct contrasts by arm are needed. The effect of low resistance versus no intervention is not established. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The preserved study is a randomized trial against 15% low-resistance sham. It is not changed into no treatment, no breathing training or a direct comparison with blood-pressure medication. Actual control exposure, sensations, attention and masking details are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Actual resistance/exposure, device, masking, concurrent care, denominators and direct contrasts by arm are needed. The effect of low resistance versus no intervention is not established.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Actual resistance/exposure, device, masking, concurrent care, denominators and direct contrasts by arm are needed. The effect of low resistance versus no intervention is not established."
    },
    {
      "item_id": "N08",
      "question_type": "Evidence condition",
      "question": "Which middle-aged and older adults were studied?",
      "needed": "Ages 50–79 and above-normal blood-pressure eligibility",
      "role": "Required",
      "role_reason": "This condition connects Ages 50–79 and above-normal blood-pressure eligibility with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Ages 50–79 and above-normal blood-pressure eligibility must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original eligibility, screening, baseline SBP, medication, sex, disease, arm baselines and subgroup denominators are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original records ages 50–79 and the bibliography describes adults with above-normal pressure. Exact eligibility, baseline medication, treatment status and comorbidity details are unverified. This is not generalized to everyone with hypertension or cardiopulmonary disease.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original eligibility, screening, baseline SBP, medication, sex, disease, arm baselines and subgroup denominators are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original eligibility, screening, baseline SBP, medication, sex, disease, arm baselines and subgroup denominators are needed."
    },
    {
      "item_id": "N09",
      "question_type": "Evidence condition",
      "question": "What do 38 randomized, 36 analyzed and 18 per arm mean?",
      "needed": "Allocation, analysis populations, completers and original denominators",
      "role": "Required",
      "role_reason": "This condition connects Allocation, analysis populations, completers and original denominators with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Allocation, analysis populations, completers and original denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Arm-specific allocation, completion/analysis flow, exclusions, missingness, ITT/effect of interest and valid blood-pressure/FMD denominators are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original records 38 randomized, 36 analyzed and 18 analyzed per arm. Completer-analysis boundaries, actual exclusion reasons and endpoint-specific denominators are separately unverified. No dropout counts or rates were newly calculated.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Arm-specific allocation, completion/analysis flow, exclusions, missingness, ITT/effect of interest and valid blood-pressure/FMD denominators are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Arm-specific allocation, completion/analysis flow, exclusions, missingness, ITT/effect of interest and valid blood-pressure/FMD denominators are needed."
    },
    {
      "item_id": "N10",
      "question_type": "Evidence condition",
      "question": "What do the six-week training numbers identify?",
      "needed": "Study-exposure duration, frequency and resistance",
      "role": "Required",
      "role_reason": "This condition connects Study-exposure duration, frequency and resistance with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Study-exposure duration, frequency and resistance must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original methods, device/resistance measurement, actual adherence/exposure, comparator and denominators are needed. Exposure numbers are preserved without becoming medication-replacement or training instructions. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original records six days weekly, 30 breaths daily, six weeks, 55% maximal inspiratory pressure in week 1, 65% in week 2 and 75% thereafter, five sets of six breaths, and 15% sham. These identify the study; no new breathing methods, device settings, procedures or total exposures were created.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original methods, device/resistance measurement, actual adherence/exposure, comparator and denominators are needed. Exposure numbers are preserved without becoming medication-replacement or training instructions.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original methods, device/resistance measurement, actual adherence/exposure, comparator and denominators are needed. Exposure numbers are preserved without becoming medication-replacement or training instructions."
    },
    {
      "item_id": "N11",
      "question_type": "Evidence condition",
      "question": "Are adherence and persistence after six weeks verified?",
      "needed": "Adherence statements and follow-up/persistence boundaries",
      "role": "Required",
      "role_reason": "This condition connects Adherence statements and follow-up/persistence boundaries with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Adherence statements and follow-up/persistence boundaries must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Adherence records, actual exposure, attrition, post-training follow-up duration/denominators, between-group effects and CIs are needed. No new maintenance methods or sustained effects are created. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original describes high adherence and results in 36 people over six weeks. Exact adherence rates/denominators and SBP persistence, maintenance or discontinuation outcomes after six weeks are not established in this summary.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Adherence records, actual exposure, attrition, post-training follow-up duration/denominators, between-group effects and CIs are needed. No new maintenance methods or sustained effects are created.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Adherence records, actual exposure, attrition, post-training follow-up duration/denominators, between-group effects and CIs are needed. No new maintenance methods or sustained effects are created."
    },
    {
      "item_id": "N12",
      "question_type": "Evidence condition",
      "question": "Is approximately 45% FMD an SBP or event effect?",
      "needed": "Relative FMD change and a separate surrogate",
      "role": "Required",
      "role_reason": "This condition connects Relative FMD change and a separate surrogate with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Relative FMD change and a separate surrogate must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original FMD values, measurement, denominators, between-group effects, CIs, timing and actual clinical-event data are needed. No new percentage-point or risk-reduction calculations are made. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original records approximately 45% relative FMD improvement and explicitly distinguishes it from a 45-percentage-point gain. FMD is a surrogate separate from SBP and is not converted into cardiovascular-event prevention.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original FMD values, measurement, denominators, between-group effects, CIs, timing and actual clinical-event data are needed. No new percentage-point or risk-reduction calculations are made.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original FMD values, measurement, denominators, between-group effects, CIs, timing and actual clinical-event data are needed. No new percentage-point or risk-reduction calculations are made."
    },
    {
      "item_id": "N13",
      "question_type": "Evidence condition",
      "question": "How far are registration and prior SBP endpoints verified?",
      "needed": "NCT03266510 and historical preregistration statements",
      "role": "Required",
      "role_reason": "This condition connects NCT03266510 and historical preregistration statements with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for NCT03266510 and historical preregistration statements must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Initial registration/change dates, original protocol, SAP, SBP/DBP/ambulatory-pressure/FMD hierarchy and analysis populations are needed. Historical preregistration statements and current reading are distinguished. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original describes a preregistered trial and the evidence item contains NCT03266510. Registration, protocol and SAP remain unread in this work; exact hierarchy, changes, multiplicity and analysis plans were not newly verified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Initial registration/change dates, original protocol, SAP, SBP/DBP/ambulatory-pressure/FMD hierarchy and analysis populations are needed. Historical preregistration statements and current reading are distinguished.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Initial registration/change dates, original protocol, SAP, SBP/DBP/ambulatory-pressure/FMD hierarchy and analysis populations are needed. Historical preregistration statements and current reading are distinguished."
    },
    {
      "item_id": "N14",
      "question_type": "Evidence condition",
      "question": "Does short-term SBP establish clinical events or medication replacement?",
      "needed": "Surrogate, cardiovascular-event and medication-replacement boundaries",
      "role": "Required",
      "role_reason": "This condition connects Surrogate, cardiovascular-event and medication-replacement boundaries with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Surrogate, cardiovascular-event and medication-replacement boundaries must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Direct clinical-event definitions, follow-up, denominators, CIs and direct medication comparisons are needed. No new risk effects or treatment-replacement instructions are created. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original records that cardiovascular-event prevention was not tested and cautions against extending the result to medication replacement. A six-week resting-SBP signal is not converted into myocardial-infarction/stroke counts or treatment-replacement effects.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Direct clinical-event definitions, follow-up, denominators, CIs and direct medication comparisons are needed. No new risk effects or treatment-replacement instructions are created.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Direct clinical-event definitions, follow-up, denominators, CIs and direct medication comparisons are needed. No new risk effects or treatment-replacement instructions are created."
    },
    {
      "item_id": "N15",
      "question_type": "Evidence condition",
      "question": "Are clinical importance and effects in other settings verified?",
      "needed": "Between-group CIs, clinical importance and applicability",
      "role": "Required",
      "role_reason": "This condition connects Between-group CIs, clinical importance and applicability with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Between-group CIs, clinical importance and applicability must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Between-group estimates, CIs, prespecified importance thresholds and direct trials/exposure in the same intervention, comparator and population are needed. No new grades or independent-replication certification are created. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "A relatively large SBP change is the original interpretation. Exact adjusted CIs, clinical importance and equivalent effects in other populations, devices, durations or activity conditions remain unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Between-group estimates, CIs, prespecified importance thresholds and direct trials/exposure in the same intervention, comparator and population are needed. No new grades or independent-replication certification are created.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Between-group estimates, CIs, prespecified importance thresholds and direct trials/exposure in the same intervention, comparator and population are needed. No new grades or independent-replication certification are created."
    },
    {
      "item_id": "N16",
      "question_type": "Evidence condition",
      "question": "Are the same report, trial and participants counted twice?",
      "needed": "Shared parent/subclaim sheets and Craighead report",
      "role": "Required",
      "role_reason": "This condition connects Shared parent/subclaim sheets and Craighead report with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Shared parent/subclaim sheets and Craighead report must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Links between original reports, cohorts, analysis populations, endpoints and follow-up measurements are needed. Report/material counts are not quality scores or unique-trial counts. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Parent 2990 and two subclaim sheets share the same Craighead 2021 bibliography/trial context. Sheets, reports, pressure/FMD endpoints and follow-up measurements do not create new independent trials/participants, and 38 randomized/36 analyzed are not added as separate people. Unique-trial and participant totals are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Links between original reports, cohorts, analysis populations, endpoints and follow-up measurements are needed. Report/material counts are not quality scores or unique-trial counts.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Links between original reports, cohorts, analysis populations, endpoints and follow-up measurements are needed. Report/material counts are not quality scores or unique-trial counts."
    },
    {
      "item_id": "N17",
      "question_type": "Evidence condition",
      "question": "Which materials were actually read?",
      "needed": "Distinguishing the stored summary from external originals",
      "role": "Required",
      "role_reason": "This condition connects Distinguishing the stored summary from external originals with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Distinguishing the stored summary from external originals must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Actual acquisition/reading records for originals, appendices, registration and plans are needed. No external material was newly retrieved or read here. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The complete stored parent-verdict summary was read. External abstracts, full text, registration, protocols and SAPs remain unread. URL, PMCID or NCT presence does not establish actual reading, access or condition fulfillment.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Actual acquisition/reading records for originals, appendices, registration and plans are needed. No external material was newly retrieved or read here.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Actual acquisition/reading records for originals, appendices, registration and plans are needed. No external material was newly retrieved or read here."
    },
    {
      "item_id": "N18",
      "question_type": "Evidence condition",
      "question": "Where are bibliography and registration identifiers recorded?",
      "needed": "PMID, PMCID, DOI and the evidence-item NCT",
      "role": "Required",
      "role_reason": "This condition connects PMID, PMCID, DOI and the evidence-item NCT with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for PMID, PMCID, DOI and the evidence-item NCT must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original paper-registration links, dates and content are needed. New URLs are not inferred from PMCID/NCT; original identifiers are preserved. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The citation list contains PMID 34184544, PMCID PMC8403283, DOI 10.1161/JAHA.121.020980 and the original PubMed URL. NCT03266510 is in the evidence item; the citation text itself contains no registration statement.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original paper-registration links, dates and content are needed. New URLs are not inferred from PMCID/NCT; original identifiers are preserved.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original paper-registration links, dates and content are needed. New URLs are not inferred from PMCID/NCT; original identifiers are preserved."
    },
    {
      "item_id": "N19",
      "question_type": "Evidence condition",
      "question": "Are historical bilingual checks the current review?",
      "needed": "Original bilingual wording and historical verification scope",
      "role": "Required",
      "role_reason": "This condition connects Original bilingual wording and historical verification scope with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Original bilingual wording and historical verification scope must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Content review of originals, translation, corrections and applicability boundaries is needed. Historical checks are not labeled as current independent clinical validation. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original Korean/English wording and historical statements about checking pressure, FMD, denominators and funding in reports, the primary trial and registration are preserved. Historical verification does not establish current external reading or completed clinical review.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Content review of originals, translation, corrections and applicability boundaries is needed. Historical checks are not labeled as current independent clinical validation.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Content review of originals, translation, corrections and applicability boundaries is needed. Historical checks are not labeled as current independent clinical validation."
    },
    {
      "item_id": "N20",
      "question_type": "Evidence condition",
      "question": "Are subclaim values separated from parent scores and axes?",
      "needed": "Original subclaim grade/note and absent score, status and axes",
      "role": "Required",
      "role_reason": "This condition connects Original subclaim grade/note and absent score, status and axes with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Original subclaim grade/note and absent score, status and axes must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Content review of selected-subclaim and parent original values is needed. No new score, axes, efficacy grade or verdict change is created. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original selected grade C/note and absent subclaim score, status and axes are preserved. Parent C54, Caution, B/S/R1/I2/E+/B2 and unrecorded precision remain parent context; they do not fill subclaim scores, axes or independence certification.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Content review of selected-subclaim and parent original values is needed. No new score, axes, efficacy grade or verdict change is created.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Content review of selected-subclaim and parent original values is needed. No new score, axes, efficacy grade or verdict change is created."
    },
    {
      "item_id": "N21",
      "question_type": "Evidence condition",
      "question": "Are the evidence date and production date distinguished?",
      "needed": "Original evidence date, correction and deliberation records",
      "role": "Required",
      "role_reason": "This condition connects Original evidence date, correction and deliberation records with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Original evidence date, correction and deliberation records must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Actual new corrections, follow-up material, complete pre-change originals and change history are needed. Existing dates and empty records are not arbitrarily filled. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original evidence date 2026-09-07, empty corrections array and empty deliberation string are retained. This is not the current production/review date or certification that no external corrections exist.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Actual new corrections, follow-up material, complete pre-change originals and change history are needed. Existing dates and empty records are not arbitrarily filled.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Actual new corrections, follow-up material, complete pre-change originals and change history are needed. Existing dates and empty records are not arbitrarily filled."
    },
    {
      "item_id": "N22",
      "question_type": "Evidence condition",
      "question": "Are public funding and company-related dimensions separated?",
      "needed": "Funding, product support, employee authors and analysis/reporting roles",
      "role": "Required",
      "role_reason": "This condition connects Funding, product support, employee authors and analysis/reporting roles with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Funding, product support, employee authors and analysis/reporting roles must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original funding, COI, device/product support, author affiliations and analysis/publication roles are needed. Parent I2 is not promoted to new independence certification. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original funding records public/nonprofit support including NIH and the American Heart Association. This does not separately verify device/product support, company-employee authors or company involvement in analysis/reporting.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original funding, COI, device/product support, author affiliations and analysis/publication roles are needed. Parent I2 is not promoted to new independence certification.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original funding, COI, device/product support, author affiliations and analysis/publication roles are needed. Parent I2 is not promoted to new independence certification."
    },
    {
      "item_id": "N23",
      "question_type": "Evidence condition",
      "question": "Are randomization, masking, measurement and selective reporting detailed?",
      "needed": "Sham-controlled design, bias and prior plans",
      "role": "Required",
      "role_reason": "This condition connects Sham-controlled design, bias and prior plans with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Sham-controlled design, bias and prior plans must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original methods, registration, protocol, SAP, measurements, denominators and change history are needed. A design label does not certify official RoB/GRADE assessment or passed review. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original design is randomized with low-resistance sham control. Allocation concealment, participant/assessor masking, pressure/FMD measurements, missingness and selective-reporting details are separately unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original methods, registration, protocol, SAP, measurements, denominators and change history are needed. A design label does not certify official RoB/GRADE assessment or passed review.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original methods, registration, protocol, SAP, measurements, denominators and change history are needed. A design label does not certify official RoB/GRADE assessment or passed review."
    },
    {
      "item_id": "N24",
      "question_type": "Evidence condition",
      "question": "Are actual exposure, adherence and concurrent care verified?",
      "needed": "Study identification versus actual exposure and cointerventions",
      "role": "Required",
      "role_reason": "This condition connects Study identification versus actual exposure and cointerventions with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Study identification versus actual exposure and cointerventions must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original actual exposure, adherence, concurrent care, missingness and intervention deviations are needed. No new total-exposure/frequency calculations, device/breathing-training or medication-change instructions are created. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original exposure and directional adherence statements remain study-identification context. Actual breathing/resistance exposure, intervention deviations, baseline/follow-up medication, diet/activity changes and detailed denominators are unverified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original actual exposure, adherence, concurrent care, missingness and intervention deviations are needed. No new total-exposure/frequency calculations, device/breathing-training or medication-change instructions are created.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original actual exposure, adherence, concurrent care, missingness and intervention deviations are needed. No new total-exposure/frequency calculations, device/breathing-training or medication-change instructions are created."
    },
    {
      "item_id": "N25",
      "question_type": "Evidence condition",
      "question": "Are possible harms separated from observed event counts?",
      "needed": "Original caution statements and actual harm collection/denominators",
      "role": "Supplementary",
      "role_reason": "This condition connects Original caution statements and actual harm collection/denominators with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Original caution statements and actual harm collection/denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original adverse-event definitions, active collection, arm-specific exposure/denominators, withdrawal, comparator and severity tables are needed. Caution is not changed into absence of harm or new safety certification. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original describes possible neck discomfort/dizziness and boundaries for certain cardiopulmonary conditions/symptoms. Possibilities do not all establish observed events; counts, incidence, collection methods, exposure denominators and CIs are unverified.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original adverse-event definitions, active collection, arm-specific exposure/denominators, withdrawal, comparator and severity tables are needed. Caution is not changed into absence of harm or new safety certification.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original adverse-event definitions, active collection, arm-specific exposure/denominators, withdrawal, comparator and severity tables are needed. Caution is not changed into absence of harm or new safety certification."
    },
    {
      "item_id": "N26",
      "question_type": "Evidence condition",
      "question": "Are long-term, rare harms and applicability verified?",
      "needed": "Six-week selected adults versus long-term harms",
      "role": "Supplementary",
      "role_reason": "This condition connects Six-week selected adults versus long-term harms with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Six-week selected adults versus long-term harms must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Actual long-term follow-up, diseases, eligibility, harm surveillance, exposure/risk time, arm denominators and CIs are needed. Unverified does not become safe or zero events. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "A six-week completer pressure study is not extended to rare-harm rates, long-term events or safety of medication replacement. Original boundaries concerning cardiopulmonary disease, chest pain and presyncope are existing statements, not new treatment decisions or procedures.",
      "condition_status": "Unverified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Actual long-term follow-up, diseases, eligibility, harm surveillance, exposure/risk time, arm denominators and CIs are needed. Unverified does not become safe or zero events.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Actual long-term follow-up, diseases, eligibility, harm surveillance, exposure/risk time, arm denominators and CIs are needed. Unverified does not become safe or zero events."
    },
    {
      "item_id": "N27",
      "question_type": "Evidence condition",
      "question": "Which materials would trigger an update?",
      "needed": "Separating originals, applied conditions, observations and verdict changes",
      "role": "Required",
      "role_reason": "This condition connects Separating originals, applied conditions, observations and verdict changes with the selected resting-SBP question, same report/population, high resistance versus low-resistance sham, within-arm versus between-group results, endpoints, times, denominators and harms.",
      "application_exception": "Preserve original numbers and study exposure only. Distinguish the 9 mmHg within-arm fall and 6 mmHg crude difference from adjusted between-group effects/CIs, resting SBP from DBP/ambulatory pressure/FMD/cardiovascular events, and 38 randomized from 36 analyzed. No new arithmetic, effects, CIs, hypothetical numbers, grades, independence certification, breathing methods, device settings, training or treatment-replacement instructions are created.",
      "criterion": "Material for Separating originals, applied conditions, observations and verdict changes must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Complete pre-change preservation, original/condition versions, separate application and content-review records are needed. Material updates and verdict changes are distinguished. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "This sheet organizes stored material concerning resting SBP. Related observations can be updated after content review of original reports, between-group effects, denominators, prior plans, endpoints, times, follow-up, support and harm data.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Complete pre-change preservation, original/condition versions, separate application and content-review records are needed. Material updates and verdict changes are distinguished.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Complete pre-change preservation, original/condition versions, separate application and content-review records are needed. Material updates and verdict changes are distinguished."
    }
  ],
  "reports": [
    {
      "report_id": "R01",
      "title": "Craighead DH, Heinbockel TC, Freeberg KA, et al. Time-Efficient Inspiratory Muscle Strength Training Lowers Blood Pressure and Improves Endothelial Function, NO Bioavailability, and Oxidative Stress in Midlife/Older Adults With Above-Normal Blood Pressure. J Am Heart Assoc. 2021;10:e020980. PMID: 34184544. PMCID: PMC8403283. DOI: 10.1161/JAHA.121.020980.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/34184544/",
      "report_type": "Low-resistance sham-controlled randomized trial",
      "existence": "The stored evidence/citation lists contain the original report bibliography. External public availability and access status are unverified.",
      "acquired_read": "Stored summary read; external paper, registration, protocols, SAPs and support disclosures unread",
      "study_family": "F01",
      "independent_replication": "The same Craighead 2021 report/population, pressure/FMD endpoints and two subclaim sheets are not counted as new independent trials, participants or replications. Review of existing content remains incomplete.",
      "observed_result": "SBP 135±2 to 126±3 versus 134±2 to 131±3 mmHg; group-by-time P=.02",
      "result_level": "Stored-summary six-week resting-SBP results. The 9 mmHg within-arm fall and 6 mmHg crude difference are existing statements; adjusted between-group effects, 95% CIs and definition of ± are unverified. DBP, ambulatory pressure, FMD, unmeasured cardiovascular events and harms remain separate.",
      "source_evidence_date": "2026-09-07",
      "materials": [
        {
          "material_type": "local_summary",
          "public_status": "Preserved copy of the complete parent-verdict stored summary",
          "access_status": "Existing stored review summary read",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-09-07",
          "qualification": "Original PubMed URL, PMID 34184544, PMCID PMC8403283, DOI 10.1161/JAHA.121.020980 and evidence-item NCT03266510 are preserved. The citation text itself has no registration statement. Identifiers alone do not certify current reading, acquisition, prior plans or condition fulfillment, and new URLs are not inferred."
        },
        {
          "material_type": "abstract",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "Original PubMed URL, PMID 34184544, PMCID PMC8403283, DOI 10.1161/JAHA.121.020980 and evidence-item NCT03266510 are preserved. The citation text itself has no registration statement. Identifiers alone do not certify current reading, acquisition, prior plans or condition fulfillment, and new URLs are not inferred."
        },
        {
          "material_type": "fulltext",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "Original PubMed URL, PMID 34184544, PMCID PMC8403283, DOI 10.1161/JAHA.121.020980 and evidence-item NCT03266510 are preserved. The citation text itself has no registration statement. Identifiers alone do not certify current reading, acquisition, prior plans or condition fulfillment, and new URLs are not inferred."
        },
        {
          "material_type": "registration",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "Original PubMed URL, PMID 34184544, PMCID PMC8403283, DOI 10.1161/JAHA.121.020980 and evidence-item NCT03266510 are preserved. The citation text itself has no registration statement. Identifiers alone do not certify current reading, acquisition, prior plans or condition fulfillment, and new URLs are not inferred."
        },
        {
          "material_type": "protocol",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
          "actually_read": "Not read",
          "as_of": null,
          "qualification": "Original PubMed URL, PMID 34184544, PMCID PMC8403283, DOI 10.1161/JAHA.121.020980 and evidence-item NCT03266510 are preserved. The citation text itself has no registration statement. Identifiers alone do not certify current reading, acquisition, prior plans or condition fulfillment, and new URLs are not inferred."
        }
      ],
      "links": [
        {
          "label": "PubMed",
          "url": "https://pubmed.ncbi.nlm.nih.gov/34184544/"
        }
      ]
    }
  ],
  "method_sources": [
    {
      "id": "M03",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2023-08",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-03",
      "section": "§3.1, §3.2.1–3.2.3, MECIR C5/C7/C13",
      "official_principle": "Clearly record the question, eligibility conditions and reasons for changes, and distinguish variations in interventions.",
      "review_level": "Preserved methodological linkages reused for production; no current methodological reassessment or external link checks, and historical quality review is not inherited"
    },
    {
      "id": "M04",
      "version": "Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03",
      "url": "https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-04",
      "section": "§4.5, §4.6.1–4.6.3, MECIR C42",
      "official_principle": "Distinguish studies from reports and link them; do not omit a study solely because results are unreported.",
      "review_level": "Preserved methodological linkages reused for production; no current methodological reassessment or external link checks, and historical quality review is not inherited"
    },
    {
      "id": "M08",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2019-10",
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      "review_level": "Preserved methodological linkages reused for production; no current methodological reassessment or external link checks, and historical quality review is not inherited"
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      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2023-08",
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      "section": "§15.2.4, §15.3.1–15.3.3",
      "official_principle": "Distinguish effect estimates, intervals, importance and applicability. Sample size alone does not determine precision.",
      "review_level": "Preserved methodological linkages reused for production; no current methodological reassessment or external link checks, and historical quality review is not inherited"
    },
    {
      "id": "M19",
      "version": "Cochrane Handbook 6.5 (2024), chapter updated 2019-10",
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      "section": "§19.1.2, §19.2.1–19.2.4",
      "official_principle": "Harm questions may require different designs, populations and follow-up from efficacy questions. Case reports do not establish incidence rates.",
      "review_level": "Preserved methodological linkages reused for production; no current methodological reassessment or external link checks, and historical quality review is not inherited"
    }
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  "status_dictionary": {
    "Partly verified": "Some information is present in the stored source, with detailed original materials still unverified; this does not mean review passed or clinical efficacy certified",
    "Unverified": "Detailed materials for the selected condition could not be established within the stored scope; this does not mean zero effect, zero studies or safety",
    "Review incomplete": "Awaiting user review",
    "Met": "Use only within the relevant condition's scope after user review; no automatic display in this preparation",
    "Not reported": "Distinguish only within materials actually read; do not turn unread external materials into unreported findings",
    "Inaccessible": "Not applied during this preparation because actual access was not tested",
    "Not applicable": "Use with a reason for non-applicability based on an explicit question boundary",
    "Conflicting data": "Judge after actual material comparison; review was not performed during this preparation",
    "Insufficient evidence for the conditions": "Do not use as a clinical grade encompassing currently unread materials"
  },
  "study_overlap": {
    "state": "Unverified",
    "unique_trial_count": null,
    "unique_participant_count": null,
    "reason": "The single Craighead 2021 report, parent 2990 and two subclaim sheets share the same trial/population context. The 38 randomized, 36 analyzed, 18 per arm, pressure/FMD endpoints and follow-up measurements are not added as new independent trials, participants or replications. Confirmed unique-trial, participant and independent-replication totals remain unrecorded."
  },
  "history": [
    {
      "date": "2026-10-16",
      "kind": "Separation of public-facing pages and materials",
      "view_version": "1.0",
      "change": "Public pages and materials were prepared from the existing 27 items. No new clinical search, verification-status change or scoring was performed."
    }
  ],
  "language": "en",
  "translation_date": "2026-10-16"
}