Response to Morning Surge, Dipping, and Sleep-Time Blood Pressure as Prognostic Markers of Cardiovascular Risk

We apologize to Hermida et al1 for not having appropriately discussed the results of the Monitorizacion Ambulatoria para Prediccion de Eventos Cardiovasculares (MAPEC)2 study. The Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA)3 and the MAPEC study2 differ under several aspects. The MAPEC study is a randomized intervention study that compares 2 different strategies: in 1 strategy, the initial monotherapy is given at bedtime; in the alternative strategy, the initial monotherapy is given in the morning.2 Randomization is stratified by agent given as initial monotherapy. Furthermore, antihypertensive treatment is adjusted not on the basis of clinic blood pressure (BP), but rather on the basis of ambulatory BP monitoring repeated after 3 months and, subsequently, at …