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The Authors' reply: We thank Chue et al1 for their letter in response to our paper.2 In general, we agree with them and are grateful to them for saying that our results are consistent with their paper where spironolactone reduced left ventricular (LV) mass in renal patients.3 There are some differences between the papers worth commenting on. In our paper, the baseline mean office systolic blood pressure (BP) was 122 mm Hg, whereas in their study, it was higher at 130 mm Hg, which is the target BP for patients with target organ damage. Therefore, only our patients were all below the target BP. Second, our patients all had echocardiographic LV hypertrophy (LVH) at baseline, whereas baseline LVH was only present in 9% to 10% of their patients. In other words, our study population was normotensive patients with LVH, whereas their study population was primarily chronic kidney disease patients with reasonably good BP control. Given that we studied somewhat different populations, it is reassuring that we found basically the same result.
It is worth commenting on a unique feature of both our studies. That relates to the magnitude of the extra BP reduction we both produced, that is, we produced an active minus placebo office BP fall of −9.2 mm Hg, whereas their corresponding figure was −6 mm Hg. This contrasts with a fall of only 4 mm Hg in the Hypertension Optimal Treatment study, 4.8 mm Hg in the Comparison of Amlodipine Versus Enalapril to Limit Occurrences of Thrombosis study and 2.4 mm Hg in Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial. This greater BP fall in our studies may explain why we got positive results, whereas the results of the Hypertension Optimal Treatment study, the Comparison of Amlodipine Versus Enalapril to Limit Occurrences of Thrombosis study and Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial study were a bit disappointing. Perhaps, a lesson to learn from both of our studies is that studies of extra BP reduction within the normal BP range ought to ensure the extra BP fall is at least in the 6 to 10 mm Hg range.
Funding Other Funders: Chief Scientist Office.
Competing interests None.
Ethics approval This study was conducted with the approval of the Tayside Committee on Medical Research Ethics and the Tayside Research and Development Consortium. It was conducted at Ninewells Hospital, Dundee, UK.
Provenance and peer review Commissioned; not externally peer reviewed.