INTENSIVE BP CONTROL FOR THE PREVENTION OF CARDIOVASCULAR EVENTS AMONG INDIVIDUALS WITH HYPERTENSION AT LOW CARDIOVASCULAR RISK: A TARGET TRIAL EMULATED USING OBSERVATIONAL DATA
Bibliographic record
Abstract
Objective: There is a lack of evidence on the optimal target blood pressure (BP) for patients with hypertension at low cardiovascular risk. Our population-based study aimed to determine whether following an intensive target BP control plan is associated with a decreased risk of major adverse cardiovascular events (MACE) compared with following a standard BP control plan in this population. Design and method: We conducted a population-based cohort study emulating a target trial. The study was based on electronic medical records from general practices in the United Kingdom. We initially created a base cohort of patients with incident hypertension at low cardiovascular risk (QRISK3-defined risk <10%). All treatment-naïve patients with systolic BP > 150 mmHg entered then the study cohort upon their first prescription for an antihypertensive drug (including combination therapy) between 1998 and 2018. The date of this prescription defined the study cohort entry date. To emulate a target trial of intensive (target BP: 130/80 mmHg), standard (140/90 mmHg), and modest (150/90 mmHg) BP control strategies, we used an active comparator, new-user cohort design with dynamic marginal structural models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for MACE. We also estimated HRs and 95% CIs for serious adverse events (SAEs), a composite endpoint including electrolyte abnormality, acute kidney injury, and antihypertensive drug-related SAEs. Results: Among 77,934 patients included in the study, adjusted incidence rates of MACE were 2.8, 3.2, and 3.3 per 1,000 persons per year in the intensive, standard, and modest strategy groups, respectively. The adjusted HRs (95% CIs) for the intensive versus standard strategy were 0.96 (0.86 to 1.08) for MACE and 0.91 (0.84 to 0.99) for SAEs. The adjusted HRs (95% CIs) for the modest versus standard strategy were 1.06 (0.97 to 1.16) for MACE and 0.99 (0.94 to 1.05) for SAEs. Cumulative hazards for MACE for the three treatment strategies during the first five years of follow-up are shown in Figure Conclusions: Compared with a standard BP control strategy, an intensive strategy was not associated with a decreased risk of MACE among hypertensive patients at low cardiovascular risk.
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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 | 0.048 | 0.037 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| 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".