Internal Medicine

BP lowering reduces major cardiovascular events early, with no progressive benefit over time

Individual-participant meta-analysis of 51 trials (358,642 participants; median follow-up 4.2 years) standardized effects to a 5-mmHg systolic reduction. A 5-mmHg systolic BP reduction was associated with HR 0.88 (0.84–0.91) for major cardiovascular events in year 1. Relative benefits were established within months and did not systematically increase with longer treatment duration. Findings were consistent across five antihypertensive drug classes, supporting prioritizing treatment for higher-risk adults. 1

LLM-assisted primary-care EMR did not lower 14-day treatment failure in a Kenyan pragmatic trial

Cluster-randomized trial in 16 facilities enrolled 9,691 patients overseen by 103 clinical officers comparing LLM-assisted versus standard EMR. Treatment failure within 14 days occurred in 102/4,693 (2.2%) intervention versus 94/4,654 (2.0%) control, adjusted OR 0.77 (0.55–1.08), P=0.13. No safety signal was identified, and any clinical benefit, if present, is likely modest. Applicability is to low-resource primary-care settings; results do not support broad adoption solely to reduce short-term treatment failure. 2

Modified Zelen delayed-consent design was acceptable to most THA trial participants

Survey of 235 CAPS-THA participants (81% response) found 76% agreed the delayed-consent design was justified after disclosure. Ninety-one percent judged the study ethically conducted and 94% reported unchanged or increased trust in research after debriefing. Seventy-one percent expressed strong willingness to join a similar future study, suggesting acceptable participant sentiment. These results support selective use of modified Zelen designs when robust post-disclosure debriefing and choices are provided. 3