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• W2099090310 abstract "HomeHypertensionVol. 58, No. 4Response to Bedtime Hypertension Treatment Increases Ambulatory Blood Pressure Control and Reduces Cardiovascular Risk in Resistant Hypertension Free AccessReplyPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReplyPDF/EPUBResponse to Bedtime Hypertension Treatment Increases Ambulatory Blood Pressure Control and Reduces Cardiovascular Risk in Resistant Hypertension Alejandro de la Sierra, Manuel Gorostidi, Julián Segura, Pedro Armario, Anna Oliveras, Jose R. Banegas and Luis M. Ruilope Alejandro de la SierraAlejandro de la Sierra Search for more papers by this author , Manuel GorostidiManuel Gorostidi Search for more papers by this author , Julián SeguraJulián Segura Search for more papers by this author , Pedro ArmarioPedro Armario Search for more papers by this author , Anna OliverasAnna Oliveras Search for more papers by this author , Jose R. BanegasJose R. Banegas Search for more papers by this author and Luis M. RuilopeLuis M. Ruilope Search for more papers by this author and on behalf of the Spanish Ambulatory Blood Pressure Monitoring Registry investigators Originally published8 Aug 2011https://doi.org/10.1161/HYPERTENSIONAHA.111.178764Hypertension. 2011;58:e27Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2011: Previous Version 1 We have read with interest the letter from Ayala et al1 concerning our article on resistant hypertension (RH).2 The first comment concerns a possible overestimation of white-coat RH by using 24-hour blood pressure (BP) as the criteria for definition of true and white-coat RH. Ayala et al1 stated that patients on ≥4 medications were true RH, and they should not be considered as having white-coat RH, even if 24-hour BP was normal. As contained in the American Heart Association definition, RH is a condition where patients remain above BP target despite the use of ≥3 medications.3 The inclusion in the definition of patients on ≥4 medications with normal clinic BP understands that these patients have been uptitrated to 4 medications because of a lack of control when they were receiving 3. This has nothing to do with the definitions of true and white-coat RH used in our article, based on 24-hour values. Patients taking ≥4 medications and controlled were not included in our analysis. Patients taking ≥4 medications and showing normal 24-hour BP were considered to have white-coat RH. If they were downtitrated to 3 drugs, they theoretically could be reclassified, but, for unknown reasons, ambulatory BP monitoring was not performed at that time. We do not consider this is a cause of overestimation.Ayala et al1 also consider that using 24-hour BP overestimates white-coat RH, because some patients might have isolated nocturnal RH. We agree with this, because it is also true that using 24-hour BP underestimates the prevalence of white-coat RH in comparison with daytime BP. Prevalences of white-coat RH in our database were 32.0%, 37.5%, and 44.1% using nighttime, 24-hour, and daytime BP, respectively. Most of the guidelines emphasize the use of daytime BP as a cutoff of true and white-coat hypertension, because this value represents more closely what is measured in the clinic. In our article,2 we discussed reasons for using 24-hour BP as the cutoff for the definition (data on daytime BP were added as supplemental material), based on the fact that it contains both activity and sleep BP. Moreover, 24-hour BP is also more reproducible and generally used for decision algorithms.4Finally, there is possibly a misunderstanding of the statement contained in our article regarding the effect of switching medication from the morning to the evening. Our results were based on a database of daily clinical practice, and we found no differences in the prevalence of true or white-coat RH in patients using all or a part of the treatment at bedtime. This was in agreement with data reported previously from our cohort also showing a lack of relationship between the use of bedtime medications and the dipping pattern.5 In our article,2 we stated that, “these data do not support that switching medication would improve ambulatory BP control,” emphasizing that this was based on a registry and not on a clinical trial. However, we are in disagreement with Ayala et al1 concerning their statement that the advantages of such medication switching are unequivocally demonstrated. Reproducibility of their results by other independent groups is mandatory, before considering a universal change in the time of administration of drugs when treating hypertensives. We must remember that most of the benefit of antihypertensive treatment in clinical trials has been obtained by giving the medications in the morning.Alejandro de la SierraManuel GorostidiJulia'n SeguraPedro ArmarioAnna OliverasJose R. BanegasLuis M. Ruilopeon behalf of the Spanish Ambulatory Blood PressureMonitoring Registry investigators Department of Internal Medicine Hospital Mutua Terrassa University of Barcelona Terrassa, SpainDisclosuresNone.FootnotesLetters to the Editor will be published, if suitable, as space permits. They should not exceed 1000 words (typed double-spaced) in length and may be subject to editing or abridgment. References 1. Ayala DE, Hermida RC, Portaluppi F, Smolensky MH. Bedtime hypertension treatment increases ambulatory blood pressure control and reduces cardiovascular risk in resistant hypertension. Hypertension. 2011; 58: e26. LinkGoogle Scholar2. De la Sierra A, Segura J, Banegas JR, Gorostidi M, de la Cruz JJ, Armario P, Oliveras A, Ruilope LM. Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoringHypertension. 2011; 57: 898– 902. LinkGoogle Scholar3. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, White A, Cushman WC, White W, Sica D, Ferdinand K, Giles TD, Falkner B, Carey RM. Resistant hypertension: diagnosis, evaluation and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008; 51: 1403– 1419. LinkGoogle Scholar4. White WB. Ambulatory blood pressure monitoring in clinical practice. N Engl J Med. 2003; 348: 2377– 2378. CrossrefMedlineGoogle Scholar5. De la Sierra A, Redon J, Banegas JR, Segura J, Parati G, Gorostidi M, de la Cruz JJ, Sobrino J, Llisterri JL, Alonso J, Vinyoles E, Pallarés V, Sarría A, Aranda P, Ruilope LM. Prevalence and factors associated with circadian blood pressure patterns in hypertensive patients. Hypertension. 2009; 53: 466– 472. LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By (2012) Current World Literature, Current Opinion in Nephrology & Hypertension, 10.1097/MNH.0b013e3283574c3b, 21:5, (557-566), Online publication date: 1-Sep-2012. October 2011Vol 58, Issue 4 Advertisement Article InformationMetrics © 2011 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.111.178764 Originally publishedAugust 8, 2011 PDF download Advertisement SubjectsClinical Studies" @default.
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