Response to Influence of Siesta in the Estimation of Blood Pressure Control in Patients With Hypertension
We thank Martínez-Moya et al1 for their interest in our article.2 First, we congratulate that their findings are consistent with ours in that ambulatory blood pressure (BP) control among treated patients with hypertension is much better than that based on office BP measurements.
Second, following the suggestion of Ben-Dov and Bursztyn in a previous letter,3 Martínez-Moya et al1 have suggested that the influence of the nap in the BP diurnal average perhaps can present erroneously higher rates of daytime BP control than real. They are probably right, and we recognized it in our response to Ben-Dov and Bursztyn.4 To overcome this issue, also following the suggestion of Ben-Dov and Bursztyn,3 we calculated 24-hour ambulatory BP control, which in fact was lower than daytime BP control (44.3% and 51.6%, respectively) but was still quite higher than office BP control (23.6%).
In their study, Martínez-Moya et al,1 ignoring siesta, obtained an overestimation in the rate of daytime ambulatory BP control of 6%, a quite remarkable percentage in these authors’ terms. However, the importance of this bias in quantitative terms will depend, among other things, on the characteristics of the individuals studied, the underlying population, and the methods used. Unfortunately, additional information on this study is not published, and, thus, we cannot assess comparability with our study.
Also, Martinez-Moya et al1 reported data on duration of siesta from a Spanish study carried out by a mattress factory with neither methods nor results published in peer-reviewed journals. According to a international survey,5 with samples of individuals representative of the general population of 5 European countries, only 7.9% of Spanish subjects reported taking naps ≥3 days a week, and the number of subjects taking a nap ≥2 times in the same day was relatively low: only 0.5% of the Spanish sample reported it. Another study,6 using a standardized questionnaire in samples of the general population of 10 countries, reported a median nap duration of 30 minutes in Spain. Anyway, even assuming that duration of siesta was ≈1 hour, its influence on average ambulatory BP values of a set of patients with hypertension in the general population should not be very large. However, we admit again that patients with hypertension who were siesta takers could undergo potentially important variations in their daytime BP.
Source of Funding
The main funding for the study was obtained from Lacer Spain, S.A., through an unrestricted educational grant. The funding body had no role in study design, analysis and interpretation of data, writing the report, or the decision to submit the paper for publication.
Martínez-Moya L, García-Noain A, Lobo-Escolar A, Gonzalvo-Liarte C, Martínez-Berganza A, Cía-Gómez P. Influence of siesta in the estimation of blood pressure control in hypertensive patients. Hypertension. 2007; 50: e14.
Banegas JR, Segura J, Sobrino J, Rodríguez-Artalejo F, Sierra A, Cruz JJ, Gorostidi M, Sarría A, Ruilope LM. Effectiveness of blood pressure control outside the medical setting. Hypertension. 2007; 49: 62–68.
Ben-Dov IZ, Bursztyn M. Is siesta masking masked hypertension? Hypertension. 2007; 49: e25.
Banegas JR, de la Sierra A, Segura J, Sobrino J, Ruilope LM. Response to is siesta masking masked hypertension? Hypertension. 2007; 49: e26.
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