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Value of Personalized Medicine--Reply.

recurrence (HR, 3.53 for recurrent lobar ICH vs 4.23 for recurrent nonlobar ICH). Vidale et al mention systemic diseases (including chronic kidney disease) as relevant contributors to ICH incidence and recurrence. We found no association between medical history of chronic kidney disease and ICH recurrence after adjusting for BP measurements (HR for lobar ICH, 1.35 [95% CI, 0.55-3.30]; HR for nonlobar ICH, 1.29 [95% CI, 0.72-2.32]). These findings may indicate lack of an independent effect of renal function abnormality on risk of ICH recurrence, once systemic pressure elevation is accounted for. We do agree, however, that chronic kidney disease and other comorbidities remain important factors to be incorporated in clinical decision making for individual patients. We agree with Vidale et al that the potential role of BP variability and circadian rhythms in determining risk of ICH recurrence is of great interest, but definitive evidence on this topic is lacking. Although additional investigation is warranted, widespread use of continuous BP monitoring to investigate the adequacy and temporal dynamics of BP control is currently not part of ICH secondary prevention guidelines, given unclear benefits in reducing risk of ICH recurrence.4,5 Furthermore, continuous BP monitoring for all survivors of ICH (outside of dedicated randomized trials) would currently be unfeasible in all but the highest-resource settings.