Reviewer's report
Title:Difference in blood pressure between early and late menopausal transition
was significant in healthy Korean women
Version:1Date:31 May 2015
Reviewer: Aris Bechlioulis
Reviewer's report:
The authors performed a cross sectional study in a health-care screening
population ow omen around menopause and investigated the association of
menopausal transition (divided in four phases according to STRAW criteria) on
blood pressure. They concluded that blood pressure and hypertension
prevalence increase moving from early to late perimenopausal period. The great
asset of the study is its large sample that permits an extensive multivariate
analysis using many confounders for adjustment. However, the cross-sectional
(and not prospective) nature of the study does not permit any causal effect
relationships to emerge as elegantly stressed in the limitation section. Few points
need to be further addressed by authors as listed below.
Minor comments
1. In several occasions throughout the study there are syntactical and grammar
errors that need to be addressed (e.g in the conclusion of abstract something is
missing to make a point, as well as in the study population). Authors should
make the appropriate corrections accordingly.
2. Although the association analysis is perfromed in the population of 2,037
subjects, in Table 1 data represents descriptives of 2,201 subjects. Authors
should probably show the descriptives in 2,037 subjects and ommit current Table
1.
3. In Table 2 the +/- symbols are missing or substituted by meaningless symbols.
Please make corrections accordingly.
4. From the results it is evident that blood pressure increases through
menopausal transition by 2.5 – 3.0 mmHg which is seemingly small and
nevertheless within normal limits. Authors should discuss about the potential
clinical effect of this increase (or probably the increase in hypertension
prevalence). Furthermore, it would be nice to report the percentage of women
that showed a greater probably more clinical meaningful increase in blood
pressure to have a picture of the actual clinical problem.
5. Vasomotor symptoms have been previously related to adverse cardiovascular
profile and prognosis in perimenopausal women. In the current study, vasomotor
symptoms were independently associated with higher diastolic blood pressure in
the population, BUT less risk for hypertension prevalence. This seems confusing
and authors should probably make a comment
6. Similar to the above comment LDL, although being associated with higher
blood pressure levels, was a negative independent predictor of hypertension.
Authors should make a comment on these incosistencies.
7. Although this is the first study investigating the effects of menopausal
transition to blood pressure using STRAW criteria for definition of various
phases, previous studies (such as the SWAN study – Matthews et al 2009 J Am
Coll Cardiol) investigated prospectively through a long term follow-up the
menopausal transition in large populations of women without showing an effect
on blood pressure after adjustment for age and other confounders. Authors
should make a comment about the differences in the results between these
studies.
8. In perimenopause estrogen levels usually rise at first before go down –
Authors should keep that in mind in the discussion.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests