Bibliographic record
Abstract
Editor—Mogensen et al interpret their results as showing that the combination of lisinopril plus candesartan was more effective than either agent alone at lowering blood pressure and reducing the urinary albumin:creatinine ratio over 24 weeks in patients with type 2 (non-insulin dependent) diabetes.1 They state, “our results . . . support this new and potentially highly beneficial therapeutic approach for the prevention of diabetic renal and vascular disease.” The authors' interpretation of the renoprotective effect of the combination and its superiority in lowering blood pressure does not seem to be supported by the results. Several methodological issues in particular limit their interpretation. Firstly, the authors state in the abstract that “the reduction in urinary albumin:creatinine ratio with combination treatment . . . was greater than with either candesartan . . . or lisinopril.” Table 4, however, shows that the difference in the albumin:creatinine ratio between lisinopril and the combination was not significant (P>0.20); they did not show that the combination was more effective than lisinopril alone. The P value for the difference between candesartan and the combination was 0.04. As numerous statistical tests were done and no correction for multiple testing was applied we question whether a P value of 0.04 is significant. Secondly, the authors report that the combination produced increases in creatinine and urea concentrations and a decrease in creatinine clearance at 24 weeks. These changes at best should be going in the opposite direction, or at least be no different if the combination is more renoprotective. Thirdly, from a methodological perspective, two factors need explaining. Firstly, patients received combination treatment only during weeks 12-24. Inexplicably, the authors compared the effects of the combined treatment (at 24 weeks) with baseline data (week 0). Secondly, 53 patients (27%) who had been enrolled in the trial were excluded from these comparisons because their diastolic pressures had been reduced to <80 mm Hg at week 12 with single treatment. In essence, the authors compared patients who received the combination (including carry-over effects from 12 weeks of single treatment) with patients who had the least response to single treatment. This is a biased comparison, and the authors should have compared single and combination treatment from 12 to 24 weeks, not from baseline. Presumably, the 53 patients were excluded because it was deemed unsafe or unnecessary to reduce their blood pressures further. It would be of concern if clinicians concluded from this study that it is beneficial to use the combination at the outset of treatment.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Editorial About the Canadian research system: no · About a Canadian topic: no | Not applicable | high |
| gpt | no category Domain: not available · Genre: Commentary About the Canadian research system: no · About a Canadian topic: no | Not applicable | high |
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.012 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.007 | 0.017 |
| Insufficient payload (model declined to judge) | 0.011 | 0.010 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedLabeled directly by 2 models reading the full record.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".