Evidence mapPaperPMID 40825205Full record

ArticleAnnals of internal medicine2025

Effect of Systolic Blood Pressure Measurement Error on the Cost-Effectiveness of Intensive Blood Pressure Targets.

Karen C Smith, Thomas A Gaziano, Alvin I Mushlin, David M Cutler, Nicolas A Menzies, Ankur Pandya

Abstract read
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Article in Annals of internal medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

Karen C SmithDepartment of Orthopedic Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (K.C.S.).ORCID 0000-0003-0330-1610
Thomas A GazianoHarvard Medical School; Center for Health Decision Science, Harvard T.H. Chan School of Public Health; and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (T.A.G.).
Alvin I MushlinDepartments of Population Health Sciences and Medicine, Weill Cornell Medical College, New York, New York (A.I.M.).ORCID 0000-0002-9298-9084
David M CutlerDepartment of Economics, Harvard University, Cambridge, Massachusetts (D.M.C.).ORCID 0000-0002-4949-8917
Nicolas A MenziesCenter for Health Decision Science and Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (N.A.M.).ORCID 0000-0002-2571-016X
Ankur PandyaCenter for Health Decision Science and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (A.P.).

Funding

NINDS NIH HHS R01 NS104143
6 · The paper itself

Abstract

backgroundAnalyses of clinical trials find that an intensive systolic blood pressure (SBP) target of less than 120 mm Hg is cost-effective compared with a target of less than 140 mm Hg for patients at high cardiovascular disease risk. However, guidelines from the American College of Cardiology and American Heart Association recommend a target of less than 130 mm Hg, citing blood pressure measurement error in routine practice.

objectiveTo evaluate the effect of measurement error on the cost-effectiveness of intensive SBP targets.

designMicrosimulation model varying SBP measurement error. DATA SOURCES: SPRINT (Systolic Blood Pressure Intervention Trial) data and published literature. TARGET POPULATION: Patients at high cardiovascular risk. TIME HORIZON: Lifetime. PERSPECTIVE: Health care sector.

interventionSBP targets of less than 120 mm Hg, less than 130 mm Hg, and less than 140 mm Hg. OUTCOME MEASURES: Incremental cost-effectiveness ratios (ICERs). RESULTS OF BASE-CASE ANALYSIS: With research-grade SBP measurement (mean error, 0 mm Hg), the ICER for the target of less than 120 mm Hg versus less than 130 mm Hg was $24 400 per quality-adjusted life-year (QALY). With average measurement error (mean error, 7.3 mm Hg in the <120-mm Hg target), the ICER increased to $42 000 per QALY. RESULTS OF SENSITIVITY ANALYSIS: The ICER for the target of less than 120 mm Hg was greater than $100 000 per QALY in scenarios with high error (mean error, ≥14.6 mm Hg in the <120-mm Hg target), when an inflection point for increasing risk for cardiovascular disease (CVD) was at or above 116 mm Hg, and in scenarios with a medication-taking disutility of at least 0.003 per antihypertensive medication. LIMITATION: Uncertainty in the relationship between low treated SBP (for example, <115 mm Hg) and cardiovascular risk.

conclusionFor SPRINT-eligible patients at high cardiovascular risk without diabetes or prior stroke, a target of less than 120 mm Hg seems cost-effective across most settings with SBP measurement error. In scenarios with high error and an increase in CVD risk at low SBPs, a target of less than 130 mm Hg may become cost-effective. PRIMARY FUNDING SOURCE: National Science Foundation and National Institute of Neurological Disorders and Stroke.

Indexed as

Antihypertensive AgentsBlood PressureBlood Pressure DeterminationHypertensionCardiovascular DiseasesCost-Benefit AnalysisHumansQuality-Adjusted Life YearsAntihypertensive Agents

Identifiers

PMID40825205
PMCPMC12875532

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.