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Comment & Response
May 2017

Cost-effectiveness of Intensive Blood Pressure Management—Is There an Additional Price to Pay?—Reply

Author Affiliations
  • 1Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
  • 2Palo Alto Veterans Affairs Health Care System, Palo Alto, California
  • 3Center for Health Policy/Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, California
JAMA Cardiol. 2017;2(5):581-582. doi:10.1001/jamacardio.2016.5837

In Reply We thank Naranjo et al for their interest in our work and for their insightful comments. We agree that intensive blood pressure management may have important consequences for renal function, and long-term follow-up of patients enrolled in the Systolic Blood Pressure Interventional Trial (SPRINT) will be informative.

The authors point out an association between acute kidney injury (AKI) and mortality, as noted by Chertow et al1 and others, and ask whether we may have overestimated the benefits of intensive blood pressure management by not modeling this risk.2 While we did not explicitly model risk of death associated with AKI, we did calibrate all-cause mortality in our model to that reported in SPRINT; any excess mortality in the intensive treatment arm associated with acute kidney injury would be incorporated into that parameter. Although the median follow-up period for patients enrolled in SPRINT was relatively short (3.26 months), the increased mortality associated with AKI begins early on and, we believe, would be captured in measures of all-cause mortality reported in SPRINT.