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. Author manuscript; available in PMC: 2020 May 13.
Published in final edited form as: N Engl J Med. 2017 Nov 30;377(22):2199–2200. doi: 10.1056/NEJMc1712465

Response to Letter Regarding Article, “Cost-Effectiveness of Intensive Versus Standard Blood Pressure Control”

Brandon K Bellows 1,2, Adam P Bress 3, Andrew E Moran 4
PMCID: PMC7220197  NIHMSID: NIHMS1033287  PMID: 29171809

We thank Sexton and colleagues for their comments. Serious adverse event (SAE) risks in SPRINT may not reflect risks among community-treated, older patients. Sexton et al.’s community-based study of SPRINT-eligible Irish adults aged ≥75 years showed injurious falls or syncope risks about five times those in SPRINT.1 However, this may be due to different methods of ascertainment for injurious falls and syncope between studies; self-report or proxy compared to those requiring an emergency department visit in SPRINT.1,2

In our analysis, we excluded injurious falls based on the results of SPRINT and SPRINT-SENIOR.2,3 However, we examined cost-effectiveness over a range of baseline and intensive treatment-related SAE risks.4 We estimated the risk of SAEs would need to be seven times the risk in SPRINT to make intensive systolic blood-pressure control lower value (i.e., ICER >$100,000/QALY). Nonetheless, SAE risk is important to consider when deciding the intensity of blood-pressure control in older patients. Health-systems and providers need an objective means to identify patients most likely to benefit from intensive blood-pressure control while at low risk of serious harms.

Disclosures:

Dr. Bress was supported by 1K01HL133468-01 and Drs. Moran and Bellows were supported by grant 5R01HL130500-02 both from the National Heart, Lung, and Blood Institute, Bethesda, MD. Dr. Bress has an institutional grant from Novartis not related to the current project.

REFERENCES

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