What does it mean to win? Interpreting hierarchical kidney outcomes in hypertension trials

Hierarchical composite kidney outcomes analyzed using win statistics prioritize important events while avoiding some limitations of traditional composite end points. Liu et al. apply this approach to 4 large hypertension trials. Their analysis illustrates how hierarchical comparisons behave when major kidney events are uncommon and most comparisons are resolved by lower-tier outcomes, in this case estimated glomerular filtration rate slope. In these settings, the win statistic largely reflects kidney function trajectories, making interpretation dependent on how slope is measured and defined.