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(Hypertension. 2006;47:e27.)
© 2006 American Heart Association, Inc.

Letters to the Editor

Response to Diurnal Blood Pressure Changes in Stroke Subtypes

Departments of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Science and Medicine, Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Tohoku University 21st Century COE Program, Sendai, Japan

Takayoshi Ohkubo

Department of Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Science and Medicine, Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Tohoku University 21st Century COE Program, Sendai, Japan

Yutaka Imai

Departments of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Science and Medicine, Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Tohoku University 21st Century COE Program, Sendai, Japan, for the Ohasama Study Group

An extract of the first 250 words of the full text is provided, because this article has no abstract.

We appreciate the comments by Tsivgoulis et al¹ regarding our article.² They pointed out the differences among our results,² their own results,³ and the results by Kario et al.⁴ In the study by Kario et al,⁴ the subjects were older, high-risk hypertensive subjects; the risk of intracerebral hemorrhage (ICH) was not adjusted by the average ambulatory blood pressure (BP) value, which is the most important confounding factor for ICH. In their cross-sectional study, Tsivgoulis et al reported that an inverted dipper–type of circadian BP variation was associated with ICH.³ Although they did adjust for baseline characteristics and ambulatory BP values, their ambulatory BP monitoring was done in a hospital setting in patients who were admitted for acute ICH. It is possible that the inverted dipper pattern in their cross-sectional study was the result of ICH.

Tsivgoulis et al also mentioned our apparent lack of adjustment for other possible confounding factors. However, even after adjustment for alcohol consumption and body mass index, the significant results did not change. With respect to the antihypertensive treatment of the study population at the time of the baseline survey, a short-acting calcium antagonist was primarily used.⁵ Although this drug may have affected circadian BP variation, the use of antihypertensive treatment did not significantly interact with the results (all P>0.7). Regarding the probable causes of ICH, there was only one case with ICH that had a history of heart disease and that was a possible candidate for anticoagulation therapy. None of the other subjects with . . . [Full Text of this Article]