Reply to: The Triglyceride to High‐Density Lipoprotein Cholesterol Ratio Is a Useful Marker to Predict Unfavorable Cardiovascular Outcomes, But Other Confounding Factors Should Be Considered

To the Editor:

We thank Dr Ünal and colleagues1 for their interest in our paper. They raised some important comments regarding our manuscript2. Firstly, the authors suggest that the effect of renin‐angiotensin system (RAS) blockade on the associated cardiovascular events was not analyzed in our study. We completely agree with this comment. Although we previously took this into consideration, we did not perform any further analysis in this context, since the number of patients on RAS blockade was similar between groups. Secondly, the authors argued that the dipping or nondipping pattern of hypertension should be included in the analysis. This is a very instructive comment. As the authors mentioned, many previous studies have shown that nondipping status/nocturnal hypertension is an independent risk factor for cardiovascular events. Unfortunately, in our patients, we were unable to use 24‐hour ambulatory blood pressure monitoring, which is not always available in clinical practice. This might be an additional limitation of our study. Thirdly, the authors suggested including insulin resistance, oxidative stress, inflammatory status, and endothelial dysfunction to the multivariate analysis. These are additional enlightening and interesting ideas, but none of the aforementioned variables are recommended in the screening of hypertensive patients in daily practice. In the present study, instead of measuring markers, which may be expensive or unavailable or unfeasible in some hypertension clinics, we examined the predictive value of triglyceride/high‐density lipoprotein cholesterol ratio on adverse outcomes, which is a routine part of hypertensive patients’ follow‐up that physicians encounter every day.

Again, we thank Dr Ünal and colleagues for their interest in our paper.