The first is about the definition of uncontrolled hypertension. In this study, we evaluated known cases of hypertension and diabetes to the achievement of hypertension control. As mentioned in the method section of the article, the measurement of blood pressure was repeated after 15 min, and the average was reported. In our study, uncontrolled hypertension was defined as having systolic blood pressure >140 or diastolic blood pressure >90 in hypertensive patients according to American Diabetes Association (ADA) guidelines the target of treatment was defined as BP<140/90 mmHg. The evaluation of blood pressure in a separate visits is a criteria that was used for diagnosis of hypertension. 1
The second concern is about the generalizability of this study to a broader population due to evaluation in a single diabetes clinic in Iran. This study was conducted in a large medical complex tertiary center affiliated with Tehran University of Medical Sciences with a high volume of patients referring to this center as one of the main referral centers in Iran. Thanks for reminding social determinants of health and providing additional data. The studied population was mostly homogenous, middle class, with middle to high school education level. Most of them had access to health care facilities and insurance and had regular follow‐up visits. Adherence to therapy was heterogeneous; patients without regular follow‐ups were not included. They had usual physical activity; we did not recommend them to have excess exercise. 2 , 3
The third concern is about the exclusion of patients younger than the age of 30 years. There are limited cases of patients younger than 30 in our patients and most of them are type1 diabetes and some Maturity Onset Diabetes of the Young (MODY) patients. Due to lack of confirmation data including genetic tests or antibody evaluations for these patients we excluded patients younger than 30 years.
CONFLICT OF INTEREST
The authors declare that they have no conflicts of interests.
AUTHOR CONTRIBUTIONS
Soghra Rabizadeh and Hossein Farrokhpour: investigation and writing, Manuchehr nakhjavani and Alireza Esteghamati: supervision, writing, review & editing.
ACKNOWLEDGMENTS
We would like to thank you for the opportunity to reply to the questions raised by Kristy Bono, et al. We also appreciate Kristy Bono, et al. for their interest in our paper. They note potential concerns about some limitations of the study.
REFERENCES
- 1. Addendum. 10. Cardiovascular disease and risk management: standards of medical care in diabetes—2021. Diabetes Care 2021;44(Suppl. 1): S125–S150. Diabetes Care. 2021;44:(9):2183–2185. 10.2337/dc21-ad09a [DOI] [PubMed] [Google Scholar]
- 2. Esteghamati A, Khalilzadeh O, Rashidi A, Kamgar M, Meysamie A, Abbasi M. Physical activity in Iran: results of the third national surveillance of risk factors of non‐communicable diseases (SuRFNCD‐2007). J Phys Act Health. 2011;8(1):27–35. [DOI] [PubMed] [Google Scholar]
- 3. Esteghamati A, Noshad S, Nazeri A, Khalilzadeh O, Khalili M, Nakhjavani M. Patterns of fruit and vegetable consumption among Iranian adults: a SuRFNCD‐2007 study. Br J Nutr. 2011;108(1):177–181. [DOI] [PubMed] [Google Scholar]