PS1-06: Increased Incident Renal Disease with ACE-1 + Thiazide Therapy for Hypertension: The Geisinger Clinic Population
Why this work is in the frame
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Bibliographic record
Abstract
Background and Aims: Thiazide diuretics are recommended alone or in combination for uncomplicated hypertension (HTN). Most patients require treatment with 2 or more drugs. Based on studies of mono-therapy, ACE-I are recommended for patients at risk of renal disease, including diabetics. Data are sparse regarding thiazide plus ACE-I combination therapy. We hypothesized that thiazide plus ACE-I is associated with a lower incidence of renal disease compared with other common thiazide combinations, but that confounding by indication for diabetes might attenuate this effect. Methods: We conducted a retrospective cohort study of thiazide combinations in a 41-site clinical practice that is the dominant provider in a large rural area. Data were extracted from an electronic medical record for all patients >60 years treated for HTN between 2001 and 2006. Patients with prevalent renal disease, or <6 months of treatment or follow-up, were excluded. Diabetes was defined as ICD9 250.* Renal disease was defined as ICD-9 codes 403.*-404.*, 593.9, 585.*-586.* or an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2. Incident renal disease by eGFR required >2 measurements persisting >3 months. Results: Among 4700 patients (98% Caucasian, 69% female, mean age 70 yrs, mean follow-up 32.5 months), the incidence of renal disease was 22.7%. Five drug categories accounted for 97% of thiazide combinations: ACE-I, Angiotensin Receptor Blocker (ARB), Beta-blocker (BB), Calcium Channel Blocker (CCB) and Potassium-sparing diuretic (P-S). In Cox models with ACEI + thiazide as the reference group, adjusted for age, sex, and pretreatment blood pressure, patients who used BB + thiazide (HR 0.72, 95% CI, 0.600.86) and CCB + thiazide (HR 0.72, 0.55–0.96) had significantly lower hazard ratios for incident renal disease than those who used ACE-I + thiazide. In analyses stratified on diabetes status, results were generally similar for patients with and without diabetes except for the suggestion of a greater rate of incident renal disease in patients without diabetes who used P-S + thiazide (HR 1.23, 1.01–1.49) compared with ACE-I + thiazide. Conclusions: Contrary to expectation, ACE-I with thiazide was associated with an increased incidence of renal disease compared with all other groups except potassium-sparing diuretics. This risk was significantly greater than that observed with BB. The association was not meaningfully changed by accounting for diabetes.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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 it