Resting Heart Rate Pattern During Follow-Up and Mortality in Hypertensive Patients
- 1 February 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Hypertension
- Vol. 55 (2), 567-574
- https://doi.org/10.1161/hypertensionaha.109.144808
Abstract
There is a linear relationship between resting heart rate (HR) and mortality in normotensive and untreated hypertensive individuals. However, it is not clear whether HR is a marker of increased risk in hypertensive patients on treatment. We investigated the relationship between HR and mortality in patients with hypertension. We analyzed baseline HR, final HR, and HR change during follow-up in patients attending the Glasgow Blood Pressure Clinic. Using a threshold of 80 bpm, we classified patients into those who had a consistently high (high-high) or low (low-low) HR or patients whose HR increased (low-high) or decreased (high-low) over time. Survival analysis was carried out using Cox proportional hazards models adjusted for age, sex, body mass index, smoking, rate-limiting therapy, systolic blood pressure, and serum cholesterol. For each beat of HR change there was a 1% change in mortality risk. The highest risk of an all-cause event was associated with patients who had increased their HR by ≥5 bpm at the end of follow-up (1.51 [95% CI: 1.03 to 2.20]; P =0.035). Compared with low-low patients, high-high patients had a 78% increase in the risk of all-cause mortality (HR: 1.78 [95% CI: 1.31 to 2.41]; P <0.001). Cardiovascular mortality showed a similar pattern of results. Rate-limiting therapy did not have an independent effect on outcomes in this analysis. Change in HR achieved during follow-up of hypertensive patients is a better predictor of risk than baseline or final HR. After correction for rate-limiting therapy, HR remained a significant independent risk factor.Keywords
This publication has 19 references indexed in Scilit:
- Relation of Beta-Blocker–Induced Heart Rate Lowering and Cardioprotection in HypertensionJournal of the American College of Cardiology, 2008
- Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trialThe Lancet, 2008
- Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease: findings from the INternational VErapamil-SR/trandolapril STudy (INVEST)European Heart Journal, 2007
- Bedside risk stratification after acute myocardial infarction: Prospective evaluation of the use of heart rate and left ventricular functionJournal of Electrocardiology, 2005
- Long-term prognostic value of resting heart rate in patients with suspected or proven coronary artery diseaseEuropean Heart Journal, 2005
- Does initial and delayed heart rate predict mortality in patients with acute coronary syndromes?Clinical Cardiology, 2004
- Predictive Value of Clinic and Ambulatory Heart Rate for Mortality in Elderly Subjects With Systolic HypertensionArchives of Internal Medicine, 2002
- Influence of heart rate on mortality among persons with hypertension: The Framingham StudyAmerican Heart Journal, 1993
- Mechanisms of action and differences in calcium channel blockersThe American Journal of Cardiology, 1986
- Importance of heart rate in determining beta-blocker efficacy in acute and long-term acute myocardial infarction intervention trialsThe American Journal of Cardiology, 1986