Response to Effect of Serum Chloride on Mortality in Hypertensive Patients
We thank Kawada for the comments1 on our article.2 We recognize the importance of lipids in outcomes. We had only baseline total cholesterol available in a subset of patients, and it was not associated with either all-cause or cardiovascular mortality. Furthermore, incorporation of baseline total cholesterol in the model did not change the association between serum chloride and mortality. This may reflect the fact that patients with high cholesterol would be actively treated during follow-up. We do not have complete and accurate statin prescription data in all our patients to explore this further. Studying the individual effect of antihypertensive medications is beyond the scope of our observational data set with no measures of adherence or persistence of treatment. We believe follow-up blood pressure is the best measure of antihypertensive effect. Finally, we point out that we studied stroke mortality rather than incident stroke, and hence we do not have the data to speculate on different underlying mechanisms. We would encourage Kawada to study the association of serum chloride with outcomes in the Japanese population as the first step in validating this finding in other ethnic groups.
Claire E. Hastie
Rajan K. Patel
Adyani Md. Redzuan
Gordon T. McInnes
Ellen Marie Freel
Anna F. Dominiczak
BHF Glasgow Cardiovascular Research Centre
Institute of Cardiovascular and Medical Sciences
University of Glasgow
Glasgow, United Kingdom
- © 2014 American Heart Association, Inc.