Outcomes in high risk hypertensives randomized to CCB vs ACE inhibitor in ALLHAT
Bibliographic record
Abstract
The clinic-based Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) studied 33,357 hypertensive participants age 55 years or older with at least one other coronary heart disease (CHD) risk factor. Interventions were chlorthalidone (C), amlodipine (A), or lisinopril (L), plus open-label step-up drugs for blood pressure control. The primary outcome was combined fatal CHD or nonfatal myocardial infarction. As well as comparisons with C, ALLHAT provides post hoc comparisons in A (n=9048, 3213 blacks) versus L (n=9054, 3210 blacks). At years 2 and 4, syst/diast BP's were higher on L vs A by 3.4/1.8 and 1.6/1.1 in blacks and 0.3/0.6 and 0.3/0.8 in non-blacks, respectively. L and A did not differ for the primary outcome (L vs A, RR and 95% CI, 1.01, 0.91–1.11). For secondary outcomes all-cause mortality and combined CHD, L and A were similar. Rates were higher on L vs A for stroke (1.23, 1.08–1.4, p=0.003) and combined CVD (1.06, 1.00–1.12, p=0.047). Stroke rates were higher in blacks (1.51, 1.22–1.86) but not in non-blacks (1.07, 0.89–1.28) on L. Combined CVD was also higher in blacks (1.13, 1.02–1.24) and not in non-blacks (1.03, 0.96–1.10) on L. For other components of combined CVD, rates were lower for HF (0.87, 0.78–0.96) and higher for peripheral arterial disease (1.19, 1.01–1.40) in both blacks and non-blacks on L vs A, and higher for hospitalized angina only in blacks (1.26, 1.03–1.55). Other endpoints, end stage renal disease and cancer rates were similar for L and A, whereas hospitalized GI bleeds were higher on L vs A (1.20, 1.06–1.37, p=0.004) in both blacks and non-blacks. For several major outcomes, risks are the same for treatment initiated with L or A, for some outcomes risks are higher on L, and for one (HF) lower on L. Most outcome differences were more prominent in blacks, resulting in an apparent overall burden of cardiovascular disease higher on L versus A in blacks but not in non-blacks. Differences in BP control appear to contribute to these differences in some outcomes, but not for others.
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How this classification was reachedexpand
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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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 itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
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".