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The Reply

      In the Letter to the Editor regarding our article,
      • Bavishi C.
      • Goel S.
      • Messerli F.H.
      Isolated systolic hypertension: an update after SPRINT.
      Dr Luger makes 2 comments—in his words “one somewhat frivolous, and the other more pointed.”
      The frivolous comment is that the population is indeed rapidly aging. First, the basis of this assertion came from the US Census Bureau, which predicts the population aged 65 years and more to be 83.7 million in 2050, almost double its estimated population of 43.1 million in 2012.
      • Ortman J.M.
      • Velkoff V.A.
      • Hogan H.
      An aging nation: the older population in the United States.
      Because of reference limits, we are unable to include many deserving references in our concise review.
      Second is the linguistic intricacy of the statement. Several credible news articles have used this phrase to highlight this issue. As stated in the CNBC news article,
      • Naidu-Ghelani R.
      Countries with aging populations.
      “The world is rapidly aging,” or as stated in the Forbes article,
      • Raposa K.
      China's aging population becoming more of a problem.
      “China is ageing more rapidly than almost any country in recent history.” Even the United Nations website
      • United Nations Department of Economic and Social Affairs, Population Division
      World population aging: 1950-2050.
      states “the twenty-first century will witness even more rapid ageing than did the century just past.” Thus, we believe our statement is clear and effectively conveys the desired message.
      In the pointed comment, the author is correct that Egan et al
      • Egan B.M.
      • Li J.
      • Hutchison F.N.
      • Ferdinand K.C.
      Hypertension in the United States, 1999 to 2012: progress toward healthy people 2020 goals.
      did not use the age groups 18 to 39 years, 40 to 59 years, and 60 years and greater; however, Liu et al
      • Liu X.
      • Rodriguez C.J.
      • Wang K.
      Prevalence and trends of isolated systolic hypertension among untreated adults in the United States.
      used these groups, and we have cited both the articles in our article. We would request the author to review Table 2 of the article by Liu et al
      • Liu X.
      • Rodriguez C.J.
      • Wang K.
      Prevalence and trends of isolated systolic hypertension among untreated adults in the United States.
      for further information.
      The author objects to the use of the word “elderly” in our article.
      • Bavishi C.
      • Goel S.
      • Messerli F.H.
      Isolated systolic hypertension: an update after SPRINT.
      We would respectfully point out that the word “elderly” is a globally accepted word. Even the randomized controlled trials Systolic Hypertension in the Elderly Program and Hypertension in the Very Elderly Trial have used the words “elderly” and “very elderly,” respectively, in their titles. A quick PubMed search (from inception to August 29, 2017) with the word “elderly” in the title and abstract only yielded 219,650 articles! Aging is commonly measured by chronological age, and, as per the World Health Organization, a person aged 65 years or more is often referred to as “elderly.”
      • World Health Organization
      Proposed working definition of an older person in Africa for the MDS project.
      We share the opinion of the author and believe that defining “elderly” solely on the basis of age cutoff is rather a simplistic approach to a complex physiologic process. The use of any term to describe advanced age should be based on a comprehensive evidence incorporating social, cultural, and medical aspects of aging.

      References

        • Bavishi C.
        • Goel S.
        • Messerli F.H.
        Isolated systolic hypertension: an update after SPRINT.
        Am J Med. 2016; 129: 1251-1258
        • Ortman J.M.
        • Velkoff V.A.
        • Hogan H.
        An aging nation: the older population in the United States.
        Curr Popul Rep. 2014; : 25-1140
        • Naidu-Ghelani R.
        Countries with aging populations.
        (Available at:)
        • Raposa K.
        China's aging population becoming more of a problem.
        (Available at:)
        • United Nations Department of Economic and Social Affairs, Population Division
        World population aging: 1950-2050.
        (Available at:)
        • Egan B.M.
        • Li J.
        • Hutchison F.N.
        • Ferdinand K.C.
        Hypertension in the United States, 1999 to 2012: progress toward healthy people 2020 goals.
        Circulation. 2014; 130: 1692-1699
        • Liu X.
        • Rodriguez C.J.
        • Wang K.
        Prevalence and trends of isolated systolic hypertension among untreated adults in the United States.
        J Am Soc Hypertens. 2015; 9: 197-205
        • World Health Organization
        Proposed working definition of an older person in Africa for the MDS project.
        (Available at:)

      Linked Article

      • An Elderly Physician's Plea
        The American Journal of MedicineVol. 131Issue 1
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          I read with interest the article by Bavishi et al1 in the December 2106 issue of The American Journal of Medicine. As a review article, it was very interesting, but I'd like to comment on 2 points, one somewhat frivolous and the other more pointed.
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