We thank the authors of the letter [1] for their interest in our paper entitled: “Association between D-Dimer and Long-Term Major Adverse Cardiovascular Outcomes in Patients with Masked Hypertension” [2].
As we mentioned in our study, we evaluated the relationship between D-dimer levels and long-term major adverse cardiovascular event (MACE) in masked hypertension patients admitted to the cardiology outpatient clinic [2]. Our study aimed to identify independent predictors of long-term MACE in masked hypertensive patients. Our focus was on the role of the D-dimer. The following are the results: (1) D-dimer was significantly related to an increased risk of long-term MACE in masked hypertensive patients; (2) ROC curve demonstrated that D-dimer has a predictive value for MACE in masked hypertensive patients.
Repeated D-dimer measurements may be considered more prognostically valuable when persistent elevations are observed rather than isolated spikes [3]. Several limitations should be considered when interpreting the results of our study. First, because this retrospective observational study was conducted at a single center, the generalizability of our findings to other populations may be limited. Second, we measured D-dimer levels only once, and repeated measurements were not analyzed. The predictive value of monitoring changes in D-dimer levels over time cannot be assessed.
Both persistent nocturnal blood pressure and excessive morning spikes independently predicted cardiovascular events in hypertensive patients [4, 5]. Our study was unable to assess these parameters due to its retrospective nature and incomplete data.
D-dimer levels may be affected by age, underlying inflammation, cancer, pregnancy, renal failure, and anticoagulant therapy [3, 6]. Our results may have been influenced by unmeasured confounding variables. Information on anticoagulant therapy, which may be a relevant confounder, was not included in our study. We have attempted to highlight in the limitations section that despite our efforts to control for multiple variables, there may be other unknown confounding factors affecting our results.
The findings of this study support the potential application of D-dimer for early risk assessment in patients with masked hypertension and potentially as a predictor of MACE in these patients. Therefore, monitoring D-dimer levels in patients with masked hypertension may help to define high-risk groups that need a more extensive diagnostic approach, including in-depth investigations, follow-up strategies, and timely and appropriate medical interventions. However, whether patients with masked hypertension benefit from treatment to lower D-dimer levels requires further study.
Conflict of Interest Statement
The authors have no conflicts of interest to declare.
Funding Sources
This study was not supported by any sponsor or funder.
Author Contributions
Conceptualization and writing – original draft, review, and editing: Ugur Köktürk.
Funding Statement
This study was not supported by any sponsor or funder.
References
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