Resting heart rate pattern during follow-up and mortality in hypertensive patients

Paul, L., Hastie, C. E., Li, W. S., Harrow, C., Muir, S., Connell, J. M.C., Dominiczak, A. F. , McInnes, G. T. and Padmanabhan, S. (2010) Resting heart rate pattern during follow-up and mortality in hypertensive patients. Hypertension, 55(2), pp. 567-574. (doi:10.1161/HYPERTENSIONAHA.109.144808)

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Publisher's URL: http://dx.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. (Hypertension. 2010;55[part 2]:567-574.)

Item Type:Articles
Keywords:ACUTE MYOCARDIAL-INFARCTION AGE BLOOD-PRESSURE CARDIOVASCULAR MORTALITY CORONARY-ARTERY-DISEASE FAILURE FOLLOW-UP heart rate hypertension IMPACT MODEL MORTALITY OUTCOMES outpatient clinics,hospital RISK risk factors RISK-FACTOR SURVIVAL SYSTOLIC HYPERTENSION THERAPY TRIAL
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Hastie, Dr Claire and Muir, Dr Scott and Connell, Professor John and McInnes, Professor Gordon and Padmanabhan, Professor Sandosh and Dominiczak, Professor Anna
Authors: Paul, L., Hastie, C. E., Li, W. S., Harrow, C., Muir, S., Connell, J. M.C., Dominiczak, A. F., McInnes, G. T., and Padmanabhan, S.
College/School:College of Medical Veterinary and Life Sciences
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Hypertension
Publisher:Lippincott Williams & Wilkins
ISSN:0194-911X
ISSN (Online):1524-4563
Published Online:28 December 2009
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
392521Regulation of aldosterone and cortisol synthesis in hypertension and cardiovascular diseaseEleanor DaviesMedical Research Council (MRC)G0400874Institute of Cardiovascular and Medical Sciences
392522Regulation of aldosterone and cortisol synthesis in hypertension and cardiovascular diseaseEleanor DaviesMedical Research Council (MRC)G0400874Institute of Cardiovascular and Medical Sciences