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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
Am J Med. Author manuscript; available in PMC 2010 August 16.
Published in final edited form as:
Am J Med. 2009 May 1; 122(5): e21.
doi:  10.1016/j.amjmed.2009.01.007
PMCID: PMC2921611

Reply to: Should physicians aggressively treat pre-hypertension?

To the editor

We appreciate the interest Dr. Garrett has shown in our work. She points out that while we described several comparisons as being not statistically significant, the magnitude of the differences we reported in mortality attributable to LVH by race and ethnicity suggests the population-wide impact of our findings might be quite large. We acknowledge that we interpreted our results conservatively but agree the implications of our findings might be greater than we implied. Although our sample might appear to be large enough to have low likelihood of a type II error, dividing it into three racial/ethnic groups limits power.

Dr. Garrett also raises the interesting question of more widespread use of echocardiography to detect LVH in subjects with pre-hypertension. Our study does not provide results that can address this question directly, but it suggests that electrocardiography may be useful in this situation given that it is predictive of mortality, is inexpensive, and is widely available. Whether electrocardiography should be part of the initial evaluation of patients with pre-hypertension is worthy of future consideration; subjects with pre-hypertension and Novacode scores greater than the thresholds we have previously described1 might benefit from drug treatment without waiting for progression to overt hypertension.


Funding sources: This studied was supported by National Heart Lung and Blood Institute grant U01 HL079160 and by Health Resources Service Award Administrative Unit Grant HP00054 5 D12.


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The author has no conflict of interest statement with regard to this correspondence. All authors had access to the data and a role in writing the manuscript. All authors of the paper this correspondence is based on reviewed and approved this manuscript.


1. Havranek EP, Emsermann CDB, Froshaug DN, Masoudi FA, Krantz MJ, Hanratty R, Estacio RO, Dickinson LM, Steiner JS. Thresholds in the relationship between mortality and left ventricular hypertrophy defined by electrocardiography. J Electrocardiol. 2008;41:342–50. [PMC free article] [PubMed]