Author Response to Letter on “Blood Pressure and Hypertension in Adolescents and Young Adults: Results From a Nationwide Screening Program”

Abstract

Dear Editor,

We thank Fatima et al. [1] for their interest in our work [2] and for their insightful comments on improving the generalizability and interpretation of our results. They also raise important areas for further research.

Our study was conducted among adolescent and young adult (AYA) males in Singapore, a city-state in South East Asia with limited geographical and environmental diversity. Regular cross-sectional surveys conducted among its citizens [3] provide insight into dietary habits and nutritional status of Singapore citizens. However, data specific to our cohort was not collected. We acknowledge the potential impact of dietary habits on hypertension and that our cohort may reflect country-specific trends [4, 5].

Our study involves a national male cohort, taking place at centralized screening center with consistency in measurement and data collection. However, we acknowledge the exclusion of females from our study cohort and emphasize caution when extrapolating our data to the other gender. Results from our study did not show a significant association between smoking and hypertension; this was also seen in recent studies also showing an inconsistent relationship shown between smoking and hypertension [6, 7]. Additionally, as mentioned in the discussion section of our paper, a dose-dependent relationship between smoking and hypertension may account for our findings [8, 9]. Nonetheless, further longitudinal studies, particularly in the AYA population, can help further clarify this relationship.

Our study was designed to evaluate the blood pressure (BP) norms of our cohort. We agree that additional longitudinal studies may provide greater insight into disease progression and trajectory of elevated BP and hypertension in the AYA population, as well as on the prognostic impact of the various diagnostic thresholds discussed in our study.

Finally, we note Fatima et al.’s comment regarding the importance of evaluating for secondary hypertension in the AYA population. We agree with its importance, and this is also reflected in the latest European Society of Cardiology Guidelines for hypertension [10], which now gives a Class IIa recommendation for screening for primary aldosteronism in individuals with hypertension. We will be conducting further analysis on individuals with hypertension from our cohort, and look forward to sharing our results in the near future.

Wesley Teck Wee Loo drafted this letter. Wilbert Hsien Hao Ho, Daniel Yan Zheng Lim, Nishanth Thiagarajan, Wee Kiat Ang, Jonathan Yong Jun Han, Shen Goy, Gerald Gui Ren Sng, Lian Kiat Lim, and Huai Yang Lim critically revised this letter. All authors approve the final version of this letter.

The authors declare that they have no competing interests.