To the Editor We read with interest the recent article by Richman et al published in JAMA Cardiology.¹ Their analysis looked at outcomes and costs for a Markov cohort model using treatment effects and adverse event rates as reported in the Systolic Blood Pressure Interventional Trial.² The authors concluded that standard blood pressure (BP) management yielded 9.6 quality-adjusted life-years and accrued $155 261 in lifetime costs, while intensive BP management yielded 10.5 quality-adjusted life-years and accrued $176 584 in costs, with intensive BP management costing $23 777 per year gained. To prefer standard BP management, serious adverse events would need to occur at 3-fold the rate observed in the Systolic Blood Pressure Interventional Trial and be 3-fold more common in the intensively managed group. However, this study did not focus on the costs that could potentially be associated with acute kidney injury (AKI) as part of the analysis.