Blood pressure control in patients aged above and below 75 years

Hae Hyuk Jung

doi:10.1371/journal.pone.0297103

Peer Review History

Original SubmissionAugust 24, 2023
2 Nov 2023 Decision Letter - Masaki Mogi, Editor PONE-D-23-27216Blood Pressure Control in Patients Aged Above and Below 75 YearsPLOS ONE Dear Dr. Jung, 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. Please submit your revised manuscript by Dec 17 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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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: The manuscript is necessary to be minor-revisioned according to the Reviewer's comments. [Note: HTML markup is below. Please do not edit.] 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: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 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). 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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: PONE-D-23-27216 This paper reported the association of BP control level with cardio-renal mortality and development of dementia in each stratified age. The author concluded that there was little benefit for cardiovascular protection by strict BP management in elderly hypertensive patients. This issue should be handled carefully, especially in clinical settings. The reviewer has several comments. 1. The author used a big data from national insurance data. The methods of BP measurement might be not same in each patient. The authors should mention this limitation for BP measurements and existence of white-coat effect. 2. In international guideline, the target BP level is decided by the status of frailty in each elderly patient. If elderly patient is not frail but keep good activity, strict BP management should be option of hypertension treatment. If the author has the data for frailty, this variable should be included in analysis. 3. The reviewer recommends the stratified analysis for CKD, diabetes, and pre-history of cardiovascular disease. In the CKD patient, target range of BP is different. 4. The association between BP and development of heart failure is important. The author should add the analysis for each outcome of cardiovascular disease, i.e., stroke, coronary artery disease, and heart failure. 5. How about diastolic BP level and outcomes in age-stratified analysis? ****** 6. 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: No ******** [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. 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Revision 1
10 Dec 2023 Author Response Ref.: Ms. No. PONE-D-23-27216 Blood Pressure Control in Patients Aged Above and Below 75 Year I thank the reviewer for his helpful comments. The manuscript has benefited from the comments. The manuscript has been rechecked and the necessary changes have been made in accordance with the reviewer’s suggestions. The responses to all comments have been prepared and are itemized below, in addition to having been implemented in the manuscript, as indicated. Review comments: Reviewer #1: This paper reported the association of BP control level with cardio-renal mortality and development of dementia in each stratified age. The author concluded that there was little benefit for cardiovascular protection by strict BP management in elderly hypertensive patients. This issue should be handled carefully, especially in clinical settings. The reviewer has several comments. 1. The author used a big data from national insurance data. The methods of BP measurement might be not same in each patient. The authors should mention this limitation for BP measurements and existence of white-coat effect. RESPONSE:, In this study, BP was measured during biennial health screenings using sphygmomanometers or oscillometric devices after at least 5-min rest. As you pointed out, BP obtained from routine office measurement is generally higher than that obtained via ambulatory or home measurement and cannot exclude white-coat effect. The Limitation section has been revised including this limitation. 2. In international guideline, the target BP level is decided by the status of frailty in each elderly patient. If elderly patient is not frail but keep good activity, strict BP management should be option of hypertension treatment. If the author has the data for frailty, this variable should be included in analysis. RESPONSE: This analysis could not address frailty due to lack of the data in the NHID although the variable of physical exercise was included in the models. The manuscript (Limitation section) has been revised including the limitation. 3. The reviewer recommends the stratified analysis for CKD, diabetes, and pre-history of cardiovascular disease. In the CKD patient, target range of BP is different. RESPONSE: At first, I regret that the additional analyses cannot be performed now because the date for accessing data has expired. However, even if possible, the stratified analyses in each age group would not provide reliable results as the number of participants in each group (e.g., CKD patients 85 years or older) was not sufficient. I have previously performed the analysis in a nationwide cohort including 359,492 CKD patients who had received antihypertensives regularly. In that analysis, the risk thresholds of on-treatment systolic BP, above which overall risk increased significantly, are around 130 mm Hg in CKD patients with proteinuria and 140 mm Hg in patients with no proteinuria (Nephrol Dial Transplant. 2022;37(6):1088). The results support that the systolic target for patients with CKD and proteinuria is ≤130 mm Hg, and the target for patients with no proteinuria is ≤140 mm Hg. In analyses performed after exclusion of participants with prior cardiovascular events, the associations of on-treatment SBP and risks of dementia and mortality were very similar to those in the primary analysis as shown in the Results (Additional analyses subsection) of the present manuscript (Tables S12-S14). I believe that the stratified analysis in patients with prior cardiovascular disease, even if possible, would not provide reliable results due to the insufficient number of participants. 4. The association between BP and development of heart failure is important. The author should add the analysis for each outcome of cardiovascular disease, i.e., stroke, coronary artery disease, and heart failure. RESPONSE: As mentioned above, I regret that the analysis cannot be performed now because the expiration date for accessing data has passed. In a previous study conducted by me and colleagues (Hypertension. 2018;71(6):1047), among active users of antihypertensives, the risks for coronary, cerebrovascular, and renal events were lowest at systolic BPs of 125–<145 mm Hg, 115–<125 mm Hg, and <115 mm Hg, respectively, and at diastolic BPs of 75–<95 mm Hg, 65–<85 mm Hg, and <75 mm Hg, respectively. 5. How about diastolic BP level and outcomes in age-stratified analysis? RESPONSE: In the study mentioned above (Hypertension. 2018;71(6):1047), J-curves were also noted for diastolic BP and the J-curves for systolic and diastolic BP had similar shapes. In my opinion, as the wide pulse pressure is commonly found in elderly patients and is associated with poor outcomes, the diastolic BP levels with the lowest risks would be more right-shifted in older patients compared with the systolic levels. I regret that this paper could not show the results clearly. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0297103.r002
27 Dec 2023 Decision Letter - Masaki Mogi, Editor Blood Pressure Control in Patients Aged Above and Below 75 Years PONE-D-23-27216R1 Dear Dr. Jung, 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, Masaki Mogi 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 ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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 #1: Yes ****** 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 ****** 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: This observational study may provide the pathological impact of BP in elderly patients. The authors responded the reviewer's comments carefully. ****** 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: No ******** https://doi.org/10.1371/journal.pone.0297103.r003
Formally Accepted
24 Jan 2024 Acceptance Letter - Masaki Mogi, Editor PONE-D-23-27216R1 PLOS ONE Dear Dr. Jung, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Masaki Mogi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0297103.r004

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