Praew Kotruchin

Abstract Severe asymptomatic hypertension is a common presentation in acute care, yet the optimal choice of oral antihypertensive therapy remains uncertain due to limited comparative evidence. We performed a systematic review and network meta-analysis of randomized controlled trials evaluating oral antihypertensive agents in adults with severe asymptomatic hypertension. Electronic databases (PubMed, Embase, CENTRAL, and CINAHL) were searched from inception to December 2025.

We thank Chen et al. [1] for their thoughtful comments on the critical importance of out-of-office blood pressure (BP) confirmation. We welcome this opportunity to discuss our methodology and place our findings in the broader context of implemental hypertension (IH)—the gap between what guidelines recommend and what actually happens in clinical practice [2]. Our finding that 80% of individuals with elevated clinic BP had white-coat hypertension (WCH) illustrates this implementation gap [3].

1 Introduction The interest in using ambulatory blood pressure monitoring (ABPM) in the evaluation of hypertensive patients in clinical practice has shown a marked increase in the past few decades. The first landmark study, reported by Perloff et al.