PONE-D-23-20485Acknowledging the Impact of Seasonal Blood Pressure Variation in Hypertensive CKD and non-CKD Patients Living in a Mediterranean ClimatePLOS ONE

Dear Dr. Aoun,

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Tauqeer Hussain Mallhi, Ph.D

Academic Editor

PLOS ONE

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Additional Editor Comments:

Dear Authors, thank you for submitting in Plos One. Your manuscript has been assessed by relevant experts from the field. They found the manuscript interesting but raised several concerns in methodology, particularly analysis section, and interpretation of results. I believe that adjustment of comparisons is required for valid conclusions. It is requested to please consider the comments of reviewers.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: There are many things to consider while measuring blood pressure, most of them are mentioned by the author but some are missed (may be author forgot to mention) which are important aspect of BP measurement. like

1. Physical environment (outdoor or indoor) and also room temperature where BP was measured has impact on BP value, as per studies, with change in room temperature BP values also varies.

2. Psychological and mental Status like anxiety, mood affects BP values. and these things need to be looked into in order to give a definitive results if the study.

Thanks,

Reviewer #2: Page 12.

Indeed, it showed that antihypertensive dose reduction and molecules’ removal occurred during the warm season whereas adding treatment was predominant in the cold season.

Clarify which antihypertensive medication were implicated in this fluctuation.

Explain and clarify the use of the word “molecule”. It does not seem to fit.

Conclusions:

Blood pressure gets lower in warm seasons and higher in cold seasons in both CKD and non-CKD hypertensive patients.

Explain is this is due to hydration status.

Reviewer #3: In this manuscript the authors describe the impact of seasonal blood pressure variation (BPV) in patients with or without chronic kidney disease (CKD) living in a Mediterranean climate. Similar seasonal BPV has been described in hypertensive patients and also among patients with chronic kidney disease (CKD). The authors conclude that treatment adjustments related to seasonal BPV may have important prognostic implications for patients.

More detail related to the methods would improve the clarity of the manuscript especially with respect to the timing of data collection. Some specific comments are presented below:

Methods

1) Variables collected: “Data collection started in August 2022” please confirm that this means “chart review was started” not collection of data for the study as it appears patients were seen between Feb 2006 and April 2020 so presumably data from this latter period was used for the analyses.

2) It is necessary to describe the interval for BP recording (between 2006-2020) was a mean for the warm/cold periods calculated for each patient? or was data just collected over the latest consecutive warm/cold periods. As the follow-up period for patients was variable (51.1 ± 44.3 months), what was the interval between T1 and T2 did this differ between CKD and non-CKD patients?

3) Seasonal variation in blood pressure has be linked with vitamin D levels. It would be helpful to know and include information on 25-OH vitamin D levels in the studied patients if available.

4) No adjustment for multiple comparisons was included.

Results

5) Consider using medication or drug instead of molecule.

6) Table 1 follow up and outcomes: As the follow-up time was variable- data on eGFR change from baseline is difficult to interpret it may be better expressed as eGFR change/year.

7) Table 3: Comparison of patients with CKD vs. non-CKD.

Were the data collection periods for CKD and non-CKD patients the same. CKD progression over a longer period may affect BPV independent of season.

8) Table 4 Please describe in table footnote what “Change of molecule” includes. There does not appear to be any difference between warm/cold season with respect to change of molecule.

Discussion

9) Paragraph 1: The authors do not address seasonal variation in 25-OH vitamin D levels as a possible contributor to BPV.

10) Paragraph 2: The authors indicate that BPV was lower among CKD cases compared to those without CKD, however, it is unclear whether this difference was significant.

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Reviewer #1: Yes: Tshering Namgay

Reviewer #2: No

Reviewer #3: No

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Attachments

Attachment

Submitted filename: Review.docx

Acknowledging the Impact of Seasonal Blood Pressure Variation in Hypertensive CKD and non-CKD Patients Living in a Mediterranean Climate

PONE-D-23-20485R1

Dear Dr. Aoun,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Tauqeer Hussain Mallhi, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: (No Response)

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: since all the things has been included in this revision, i would say this study will have a great impact on the treatment module for Hypertensive patients.

thanks

Reviewer #3: The authors have added additional description to the methods significantly improving clarity of the manuscript. Limitations are now more fully discussed. I have no further comments.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Tshering Namgay

Reviewer #3: No

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