Response to Comment on “Soluble Receptor for Advanced Glycation End Products and Incident Hypertension in REGARDS”

We thank Dr Shen and colleagues for their thoughtful comments on our recent article, "Soluble Receptor for Advanced Glycation End Products (sRAGE) and Incident Hypertension in REGARDS." 1 They raise 3 key concerns: (1) the treatment of missing dietary data and the role of diet as a potential confounder, (2) kidney function and its impact on sRAGE levels, and (3) statin use and its potential influence on sRAGE levels.Regarding missing dietary data, we used the Life's Simple 7 dietary metric to quantify the quality of diet in the population as poor (0-1 healthy dietary components), intermediate (2-3 components), or ideal (4-5 components).Nationally, diet quality in the United States was previously estimated to be 76% for poor, 24% for intermediate, at <0.5% for ideal. 2 In REGARDS, the distribution among participants with available dietary is similar to national data (80.24%,19.71%, and 0.05% for poor, intermediate, and ideal, respectively).Dietary data are considered missing not at random in REGARDS given differential completion of the Food Frequency Questionnaire based on sociodemographics.Therefore, conventional non-deterministic imputation methodologies (eg, multiple imputation) cannot be used. 3To assess whether assigning a "poor" score to missing diets over adjusted results, we performed two sensitivity analyses, which are shown in Table 1.The first assigned missing dietary scores a value of "intermediate", the second excluded persons with missing dietary data.The overall associations between sRAGE and risk of incident hypertension remained consistent with our manuscript when performing these sensitivity analyses, suggesting it is unlikely that our primary analysis was mired by excessive over attenuation.