Reply to Letter to the Editor: The proper blood pressure may impaire cardiovascular risk factors

We are very delighted about the international interest in ourpaper “Uncontrolled arterial hypertension in primary care –patient characteristics and associated factors” (Swiss MedWkly. 2012;142:w13693). We are especially delighted thatour work obviously is not only recognised by primary carephysicians, but also by specialists as the letter to the editorby Sait Demirkol [1] reflects.We are also thankful for the comment regarding the crosssectional design of our study. We agree with Demirkol andcolleagues that a cross sectional design can only show cor-relations but not prove any causality. This would only bepossible – as suggested by Demirkol et al. – by a followup. The data presented in our paper are derived from thebaseline-assessment of the CoCo trial, a randomised, con-trolled trial aiming at improving blood pressure control byusing a colour coded booklet for patients to note their bloodpressure measurements (Trials. 14 April 2010;11:38).It is our aim to follow the patients included in CoCo forat least one year. Therefore, we will be able – controlledfor the intervention – to analyse the influence of the de-tected risk factors for elevated blood pressure, namely age,smoking and a high body mass index over time. We arelooking forward to present these data soon.We agree with Demirkol and colleagues that patients withestablished cardiovascular diseases have a dysregulation ofvascular tone thus further promoting atherosclerosis. Asa consequence, blood pressure control by pharmacologic-al agents might differ depending on pleiotropic effects ofthese agents beyond blood pressure lowering, includinganti-oxidative and anti-inflammatory actions (Curr VascPharmacol. 2011 Mar;9(2):145–52, Clin Exp Hypertens.2012 Nov 30. [Epub ahead of print]). To investigate theeffect of various pharmacological agents was beyond thescope of the current study and unfortunately as stated inthe strengths and limitations section of our paper, co-mor-bidities were not systematically assessed. Therefore we arenot able to stratify for the factors: coronary artery disease,hypercholesterolemia or diabetes mellitus. Nevertheless,there is sufficient evidence that successful modification oflifestyle risk factors have a beneficial effect on blood pres-sure control irrespective of cardiovascular co-morbidities.Our cross-sectional results confirmed that the prevalence ofmodifiable cardiovascular risk factors is high in unselectedpatients with uncontrolled blood pressure thus demonstrat-ing the potential of successful lifestyle change programmesas mentioned by Demirkol and colleagues (Oman Med J.2012;27(6):511).