Abstract 107: Effect Of Intensive Blood Pressure Control On Incident Stroke Risk In Patients With Mild Cognitive Impairment
Bibliographic record
Abstract
Background: Patients with mild cognitive impairment (MCI) are at higher risk of incident stroke, but the effect of intensive blood pressure (BP) control on that risk has not been explored. Methods: We performed a post-hoc analysis of the SPRINT trial and included patients with a baseline Montreal Cognitive Assessment (MoCA) score of 20-26 and without a prior history of stroke. The primary outcome was incident stroke (ischemic and hemorrhagic) during follow-up. We estimated the risk of our primary outcome by SPRINT randomization arm (intensive vs. standard BP control) and fit Cox models for the primary outcome, adjusting for patient age, race, sex, baseline blood pressure, atrial fibrillation, diabetes, and smoking. We also verified the proportional hazards assumption of our final model. Results: We included 5507 patients (mean age 67.8 + 9.4 years, 66.6% male, 59.5% non-Hispanic white, and 50.1% randomized to intensive BP control), of which 94/5507 (1.7%) had an incident stroke during a mean of 3.8±0.9 years of follow-up. The risk of incident stroke in patients randomized to intensive BP control was 37/2762 (1.3%) and to standard BP control was 57/2745 (2.1%). In the adjusted Cox model, the hazard ratio for incident stroke events with intensive BP control was 0.63 (95% CI 0.42-0.96, p=0.03). The Kaplan-Meier curve by randomization arm is seen in Figure 1. Conclusion: Although the SPRINT trial failed to show a reduction in stroke with intensive BP control for all subjects, those with MCI at baseline may benefit from intensive BP control to lower risk of incident stroke. Future trials of primary prevention of stroke or vascular cognitive impairment and dementia could benefit from enrichment using baseline biomarkers of elevated risk, such as mild cognitive impairment.
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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 | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".