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Yet another study appearing in the New England Journal of Medicine reports the results of a randomized clinical trial conducted in China, designed to compare

Yet another study appearing in the New England Journal of Medicine reports the results of a randomized clinical trial conducted in China, designed to compare the efficacy of two treatments for hypertension in older adults.

With regards to study design, the researchers report:

"In this multicenter, randomized, controlled trial, we assigned Chinese patients 60 to 80 years of age with hypertension to a systolic blood-pressure target of 110 to less than 130 mm Hg (intensive treatment) or a target of 130 to less than 150 mm Hg (standard treatment). The primary outcome was a composite of stroke, acute coronary syndrome (acute myocardial infarction and hospitalization for unstable angina), acute decompensated heart failure, coronary revascularization, atrial fibri-lation, or death from cardiovascular causes."

"Of the 9624 patients screened for eligibility, 8511 were enrolled in the trial; 4243 were randomly assigned to the intensive-treatment group and 4268 to the standard-treatment group"

Enrolled patients were follow-up for up to one year after randomization. The following Kaplan-Meier was included to show the primary findings from the study:

The Cox proportional hazard model used to quantify this association is as follows:

ln(hazard at time t)=ln(^o(t))+0.30x1ln(hazard at time t)=ln(^o(t))+0.30x1 with x1= 1 for "Intensive Treatment" and 0 for "Standard Treatment"

In the population from which the study sample was taken, subjects with a history of smoking have an elevated risk of death compared to subjects without a history of smoking. Suppose the researchers were to estimate the smoking history adjusted hazard ratio of death for the "Intensive Treatment" group compared to the "Standard Treatment" group. Likely, how will this adjusted hazard ratio compare to the unadjusted hazard ratio?

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