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PONE-D-23-08509BURDEN OF UNDIAGNOSTIC HYPERTENSION ANN ASSOCIATED FACTORS: A CHALLENGE FOR PRIMARY HEALTH CAREPLOS ONE

Dear Dr. Salazar Flórez,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The manuscript has been reassessed by one reviewer. The comments are appended below. The reviewer observe major concerns about the manuscript, and in particular they feel that important methodological issues exist that affect the technical soundness of your study, and the conclusions of the paper. We request authors to conduct a detailed review of the comments. 

Please submit your revised manuscript by Aug 19 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Bruno Pereira Nunes, Ph.D.

Academic Editor

PLOS ONE

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This study was funded by the San Martin University Foundation (PY-2020-025).

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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: No

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

Reviewer #1: 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

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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: No

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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: Although the manuscript focused on a topic of public health importance, it needs major revision as follows:

1. The English language needs professional editing throughout the manuscript.

2. The title does not make sense. The word “undiagnostic” in the title should be replaced by "undiagnosed". The title should include the geographical area of the study population. Suggested title may be "Burden of undiagnosed hypertension and its associated factors: A challenge for primary health care in urban Colombia"

3. The words “undiagnosed” and “unscreened” were used interchangeably in the manuscript. I suggest using either the word "undiagnosed" or "unscreened" consistently across the manuscript. I prefer “undiagnosed”.

4. In the method section use the geographical areas from where the study population were selected clearly.

5. The authors used words like “incidence” (sentence 168); Risk Ratio (sentence 169); incidence rate ratio (sentence 174) which are wrong for this study as it is a cross-sectional study.

6. The primary dependent variable for this study is undiagnosed hypertension. However, the authors primarily focused on all hypertension (both diagnosed and undiagnosed) in all analyses. My observation and suggestion are as follows:

i. 38.5% is the overall prevalence of hypertension and half (50.9%) of them are unscreened. So, there are three categories of participants in respect to hypertension: 1) Normotensive, 2) undiagnosed hypertensive, and 3) diagnosed hypertensive. I suggest using a multinomial logistic regression with three category outcome to identify the associated factors of undiagnosed hypertension with normotensive as the reference category.

7. As the number of “no formal education” is low (Table 1), add them with primary education category.

8. In table 2, number of the normal BMI is missing.

9. In sentence 265, the authors mentioned the prevalence of undiagnosed hypertension is 50.9%. I guess this is the prevalence of undiagnosed hypertension among the hypertensive population. Be sure of it.

10. In the figure 1, the authors classified the hypertensive status as “unscreened”, “unaware”, “untreated”, “uncontrolled”, and “health risk”. However, these are not shown in the results, although these are important.

11. Figure 2 is not clear at all. The figure color and legend captions are not related. Either make it clear or delete it.

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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: Dipak Kumar Mitra

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

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Attachments

Attachment

Submitted filename: PONE-D-23-08509_reviewer_dm.pdf

Attachment

Submitted filename: Comments of the manuscript-PONE-D-23-08509_reviewer_dm.docx

PONE-D-23-08509R1BURDEN OF UNDIAGNOSED HYPERTENSION AND ITS ASSOCIATED FACTORS: A CHALLENGE FOR PRIMARY HEALTH CARE IN URBAN COLOMBIAPLOS ONE

Dear Dr. Salazar Flórez,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The manuscript has been reassessed by two reviewers. The comments are appended below. We request authors to conduct a review of the comments providing detailed answers. 

Please submit your revised manuscript by Dec 03 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Bruno Pereira Nunes, Ph.D.

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

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 #2: All comments have been addressed

Reviewer #3: (No Response)

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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 #2: Yes

Reviewer #3: (No Response)

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

Reviewer #2: Yes

Reviewer #3: (No Response)

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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 #2: Yes

Reviewer #3: (No Response)

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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 #2: Yes

Reviewer #3: (No Response)

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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 #2: Please check the use of HTN (sometimes HNT is used in error).

Please clarify education level, it sometimes reads as the level of current education, but you maximum leel of education gained. Phrases such as 'people in primary school' can be misleading.

It would be nice to add a reference for the population projection (DANE).

Lines 316/317 - I am not sure you mean less health conscious, but maybe they feel they are healthier and probably are healthier so less likley to get checked or screened? I agree with the latter part that they are less susceptible to other diseases.

Line 371 - be more explicit. Familiy history was not accounted for as a covariate?

Reviewer #3: Thank you for the opportunity to review the manuscript “Burden of undiagnosed hypertension and its associated factors: a challenge for primary health care in urban Colombia”.

The introduction is to long, almost 3 pages. I suggest you be more succinct.

It doesn't make sense for the sentence "Health policymakers might require such empirical evidence to create targeted strategies for controlling HTN both in the country and the world" to be after the objectives. It fits in with the discussion rather than the introduction.

The sample size is not adequate given that at least 306 participants were supposed to be interviewed (not counting the 10% that is recommended to be added for losses and refusals), and only 286 were interviewed.

Please check all manuscript and avoid sentences like "hypertensive participants". Change to "participants with hypertension". The same for obese, avoid “were obese or overweight”. Instead, use had obesity of overweight.

In general, the manuscript provides interesting results that show a high rate of underdiagnosed cases of hypertension. The failure to reach 100% of the sample calculation needs to be discussed as a limitation. Pejorative terms such as hypertensive people and obese people need to be revised throughout the text. I would also suggest a grammatical review of the English, I believe that some sentences could be rewritten for better understanding.

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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 #2: Yes: Holly Pavey

Reviewer #3: No

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

BURDEN OF UNDIAGNOSED HYPERTENSION AND ITS ASSOCIATED FACTORS: A CHALLENGE FOR PRIMARY HEALTH CARE IN URBAN COLOMBIA

PONE-D-23-08509R2

Dear Dr. Salazar Flórez,

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.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Bruno Pereira Nunes, 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 #2: 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 #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #2: Yes

Reviewer #3: Yes

**********

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 #2: 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 #2: Yes

Reviewer #3: Yes

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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 #2: Thank you for addressing the comments, I am happy that the suggested comments have been addressed and changes mafe to the manuscript and therefore the manuscript has been much improved.

Reviewer #3: The authors made corrections and suggestions throughout the text. I now consider the manuscript approved for publication.

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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 #2: No

Reviewer #3: Yes: Felipe Delpino

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