# High-resistance IMST × six-week resting systolic blood pressure: evidence gaps

Verdict 2990 · Evidence Check

Stored-material review date: Not recorded  
Original evidence cut-off: 2026-09-07  
Review-criteria version: 1.0  
Public page/material preparation date: 2026-10-16

Clinical papers were not read directly; existing review summaries were checked. No new clinical-literature search was performed. Unverified does not mean that research is absent or that there is no effect.

## Assessment scope

- 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.
- Ingredient, formulation and route: 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.
- Measured outcome: 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.
- Questions outside this scope: 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

## Checklist items

### N01 · Which resting systolic-pressure claim is examined?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: 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.
- Required materials and conditions: Selected lower resting systolic-pressure claim
- Materials to obtain first: 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.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N02 · What are the original six-week resting-pressure values?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: 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.
- Required materials and conditions: Baseline and six-week resting SBP by arm
- Materials to obtain first: 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.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N03 · Are 9 mmHg and 6 mmHg adjusted between-group effects?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: 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.
- Required materials and conditions: Within-arm fall, crude difference in changes and adjusted effect
- Materials to obtain first: 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.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N04 · Does group-by-time P=.02 provide an exact effect and CI?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: The test model, interaction/direct contrast, adjusted estimate, CI, prespecified importance threshold and original denominators are needed.
- Required materials and conditions: Distinguishing tests, effect estimates and precision
- Materials to obtain first: The test model, interaction/direct contrast, adjusted estimate, CI, prespecified importance threshold and original denominators are needed.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N05 · Is diastolic P=.17 the same result?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: DBP measurement conditions, original arm values, denominators, effects, CIs, prespecified hierarchy and original analysis tables are needed.
- Required materials and conditions: Separate resting SBP and DBP endpoints
- Materials to obtain first: DBP measurement conditions, original arm values, denominators, effects, CIs, prespecified hierarchy and original analysis tables are needed.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N06 · Are ambulatory and 24-hour pressure equally established?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: 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.
- Required materials and conditions: Resting versus ambulatory measurement conditions
- Materials to obtain first: 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.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N07 · Was the actual control low-resistance sham?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: 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.
- Required materials and conditions: High resistance versus 15% low-resistance sham
- Materials to obtain first: 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.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N08 · Which middle-aged and older adults were studied?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Original eligibility, screening, baseline SBP, medication, sex, disease, arm baselines and subgroup denominators are needed.
- Required materials and conditions: Ages 50–79 and above-normal blood-pressure eligibility
- Materials to obtain first: Original eligibility, screening, baseline SBP, medication, sex, disease, arm baselines and subgroup denominators are needed.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N09 · What do 38 randomized, 36 analyzed and 18 per arm mean?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Arm-specific allocation, completion/analysis flow, exclusions, missingness, ITT/effect of interest and valid blood-pressure/FMD denominators are needed.
- Required materials and conditions: Allocation, analysis populations, completers and original denominators
- Materials to obtain first: Arm-specific allocation, completion/analysis flow, exclusions, missingness, ITT/effect of interest and valid blood-pressure/FMD denominators are needed.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N10 · What do the six-week training numbers identify?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Original methods, device/resistance measurement, actual adherence/exposure, comparator and denominators are needed. Exposure numbers are preserved without becoming medication-replacement or training instructions.
- Required materials and conditions: Study-exposure duration, frequency and resistance
- Materials to obtain first: Original methods, device/resistance measurement, actual adherence/exposure, comparator and denominators are needed. Exposure numbers are preserved without becoming medication-replacement or training instructions.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N11 · Are adherence and persistence after six weeks verified?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: 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.
- Required materials and conditions: Adherence statements and follow-up/persistence boundaries
- Materials to obtain first: 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.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N12 · Is approximately 45% FMD an SBP or event effect?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: 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.
- Required materials and conditions: Relative FMD change and a separate surrogate
- Materials to obtain first: 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.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N13 · How far are registration and prior SBP endpoints verified?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: 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.
- Required materials and conditions: NCT03266510 and historical preregistration statements
- Materials to obtain first: 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.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N14 · Does short-term SBP establish clinical events or medication replacement?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Direct clinical-event definitions, follow-up, denominators, CIs and direct medication comparisons are needed. No new risk effects or treatment-replacement instructions are created.
- Required materials and conditions: Surrogate, cardiovascular-event and medication-replacement boundaries
- Materials to obtain first: Direct clinical-event definitions, follow-up, denominators, CIs and direct medication comparisons are needed. No new risk effects or treatment-replacement instructions are created.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N15 · Are clinical importance and effects in other settings verified?

Verification status: Unverified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: 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.
- Required materials and conditions: Between-group CIs, clinical importance and applicability
- Materials to obtain first: 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.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N16 · Are the same report, trial and participants counted twice?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: 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.
- Required materials and conditions: Shared parent/subclaim sheets and Craighead report
- Materials to obtain first: 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.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N17 · Which materials were actually read?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Actual acquisition/reading records for originals, appendices, registration and plans are needed. No external material was newly retrieved or read here.
- Required materials and conditions: Distinguishing the stored summary from external originals
- Materials to obtain first: Actual acquisition/reading records for originals, appendices, registration and plans are needed. No external material was newly retrieved or read here.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N18 · Where are bibliography and registration identifiers recorded?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Original paper-registration links, dates and content are needed. New URLs are not inferred from PMCID/NCT; original identifiers are preserved.
- Required materials and conditions: PMID, PMCID, DOI and the evidence-item NCT
- Materials to obtain first: Original paper-registration links, dates and content are needed. New URLs are not inferred from PMCID/NCT; original identifiers are preserved.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N19 · Are historical bilingual checks the current review?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Content review of originals, translation, corrections and applicability boundaries is needed. Historical checks are not labeled as current independent clinical validation.
- Required materials and conditions: Original bilingual wording and historical verification scope
- Materials to obtain first: Content review of originals, translation, corrections and applicability boundaries is needed. Historical checks are not labeled as current independent clinical validation.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N20 · Are subclaim values separated from parent scores and axes?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Content review of selected-subclaim and parent original values is needed. No new score, axes, efficacy grade or verdict change is created.
- Required materials and conditions: Original subclaim grade/note and absent score, status and axes
- Materials to obtain first: Content review of selected-subclaim and parent original values is needed. No new score, axes, efficacy grade or verdict change is created.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N21 · Are the evidence date and production date distinguished?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Actual new corrections, follow-up material, complete pre-change originals and change history are needed. Existing dates and empty records are not arbitrarily filled.
- Required materials and conditions: Original evidence date, correction and deliberation records
- Materials to obtain first: Actual new corrections, follow-up material, complete pre-change originals and change history are needed. Existing dates and empty records are not arbitrarily filled.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N22 · Are public funding and company-related dimensions separated?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Original funding, COI, device/product support, author affiliations and analysis/publication roles are needed. Parent I2 is not promoted to new independence certification.
- Required materials and conditions: Funding, product support, employee authors and analysis/reporting roles
- Materials to obtain first: Original funding, COI, device/product support, author affiliations and analysis/publication roles are needed. Parent I2 is not promoted to new independence certification.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N23 · Are randomization, masking, measurement and selective reporting detailed?

Verification status: Unverified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: 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.
- Required materials and conditions: Sham-controlled design, bias and prior plans
- Materials to obtain first: 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.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N24 · Are actual exposure, adherence and concurrent care verified?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: 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.
- Required materials and conditions: Study identification versus actual exposure and cointerventions
- Materials to obtain first: 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.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N25 · Are possible harms separated from observed event counts?

Verification status: Unverified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: 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.
- Required materials and conditions: Original caution statements and actual harm collection/denominators
- Materials to obtain first: 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.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N26 · Are long-term, rare harms and applicability verified?

Verification status: Unverified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: 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.
- Required materials and conditions: Six-week selected adults versus long-term harms
- Materials to obtain first: 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.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

### N27 · Which materials would trigger an update?

Verification status: Partly verified  
Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread

- Current findings: 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.
- Why unverified: 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.
- Reason for missing information: Complete pre-change preservation, original/condition versions, separate application and content-review records are needed. Material updates and verdict changes are distinguished.
- Required materials and conditions: Separating originals, applied conditions, observations and verdict changes
- Materials to obtain first: Complete pre-change preservation, original/condition versions, separate application and content-review records are needed. Material updates and verdict changes are distinguished.
- Further 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.
- Conditions for verification: 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.
- Why this condition is needed: 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 exceptions: 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.
- Remaining 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.
- Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.
- Related sources: R01

## Evidence and sources

### R01

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.

[PubMed](https://pubmed.ncbi.nlm.nih.gov/34184544/)

Materials actually read: Stored summary read; external paper, registration, protocols, SAPs and support disclosures unread  
Findings recorded in the summary: SBP 135±2 to 126±3 versus 134±2 to 131±3 mmHg; group-by-time P=.02  
Record 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.  
Independent replication: 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.

| Material | Public availability | Access status | Actually read | Notes |
|---|---|---|---|---|
| local_summary | Preserved copy of the complete parent-verdict stored summary | Existing stored review summary read | Summary read | 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. |
| abstract | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | 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. |
| fulltext | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | 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. |
| registration | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | 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. |
| protocol | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | 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. |

## Review criteria and methods

These are Chamgap's own application conditions, informed by the relevant sections of official methodological guidance. They do not constitute official assessment-tool certification or a new efficacy score.

- M03 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-03) · §3.1, §3.2.1–3.2.3, MECIR C5/C7/C13 · Clearly record the question, eligibility conditions and reasons for changes, and distinguish variations in interventions. · Preserved methodological linkages reused for production; no current methodological reassessment or external link checks, and historical quality review is not inherited
- M04 [Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-04) · §4.5, §4.6.1–4.6.3, MECIR C42 · Distinguish studies from reports and link them; do not omit a study solely because results are unreported. · Preserved methodological linkages reused for production; no current methodological reassessment or external link checks, and historical quality review is not inherited
- M08 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-08) · §8.1–8.2.3, Table 8.2.a · Define the outcome and effect of interest, then examine randomization, deviations, missing data, measurement and selective reporting. · Preserved methodological linkages reused for production; no current methodological reassessment or external link checks, and historical quality review is not inherited
- M15 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-15) · §15.2.4, §15.3.1–15.3.3 · Distinguish effect estimates, intervals, importance and applicability. Sample size alone does not determine precision. · Preserved methodological linkages reused for production; no current methodological reassessment or external link checks, and historical quality review is not inherited
- M19 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-19) · §19.1.2, §19.2.1–19.2.4 · Harm questions may require different designs, populations and follow-up from efficacy questions. Case reports do not establish incidence rates. · Preserved methodological linkages reused for production; no current methodological reassessment or external link checks, and historical quality review is not inherited

## What the statuses mean

- 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

## Change history

2026-10-16 · Public page/materials 1.0. Public pages and materials were prepared from the existing 27 items. No new clinical search, verification-status change or scoring was performed.