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In Reply: Drs Coca and Parikh note that CKD might have confounded our findings regarding the association between diurnal blood pressure pattern and the development of CHF. We agree that CKD is associated with an altered diurnal blood pressure pattern. Furthermore, several recent studies have highlighted the association between kidney function and incident CHF.^1-3 Even though we did not regard CKD as one of the major established risk factors for CHF, we agree that decreased kidney function was a potential confounder that was not considered in the study.

Fortunately, serum creatinine was measured with spectrophotometry using Jaffe's reaction at baseline in 935 (98%) of the 951 participants in the original study. Estimations of GFR were done using the established Cockcroft-Gault⁴ and Modification of Diet in Renal Disease (MDRD)⁵ equations. In response to Coca and Parikh, we performed post hoc analyses, adding these measurements of kidney function to the multivariable models . . . [Full Text of this Article]

Erik Ingelsson, MD, PhD
erik.ingelsson@pubcare.uu.se

Kristina Björklund-Bodegård, MD, PhD
Department of Public Health and Caring Sciences

Lars Lind, MD, PhD
Department of Medical Sciences

Johan Ärnlöv, MD, PhD
Department of Public Health and Caring Sciences

Johan Sundström, MD, PhD
Department of Medical Sciences
Uppsala University
Uppsala, Sweden

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Congestive Heart Failure and Diurnal Blood Pressure Pattern
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JAMA. 2006;296(23):2799-2800.
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