Heart rate distribution and predictors of increased heart rate among French hypertensive patients with stable coronary artery disease. Data from the LHYCORNE cohort.
BACKGROUND
Heart rate is a key determinant of both myocardial ischaemia and prognosis in patients with coronary disease. Reducing heart rate is known to relieve ischaemia and improve cardiovascular prognosis. Currently there is no information about heart rate distribution and predictors of high heart rate in patients with stable coronary artery disease (CAD).


METHODS
The L'Hypertendu Coronarien Vu En Médecine Générale (LHYCORNE) cohort was a prospective observational study involving consecutive stable CAD patients with treated hypertension. Patients with atrial fibrillation were excluded from the analysis. Heart rate distribution and factors independently associated with heart rate above that of the cohort mean were analysed.


RESULTS
The study population comprised 8922 stable CAD patients in sinus rhythm (76% were men; mean age 66+/-11 years; mean systolic/diastolic blood pressures 141/82mmHg; 26% had diabetes). The mean resting heart rate was 70+/-6 bpm; the distribution was: 7% for <60 bpm, 38% for 60-69, 38% for 70-79bpm, 14% for 80-89bpm, and 2% for>90bpm. The mean resting heart rate of the patients on beta-blockers (62% of the population) was 69+/-8bpm versus 73+/-8bpm in subjects not on beta-blockers (p<0.001). Eight independent predictors of heart rate>/=70bpm were identified.


CONCLUSIONS
Data from this large cohort demonstrate that few patients meet recommendations to lower heart rate to <60bpm. Over 50% of stable CAD patients had a heart rate>/=70bpm, presenting a particularly high-risk profile. Given the therapeutic and prognostic role of resting heart rate in CAD patients, our findings emphasize the need to consider heart rate in these high-risk patients.
Lorgis
Luc
L
Service de cardiologie, CHU Bocage, boulevard Maréchal-de-Lattre-de Tassigny, Dijon, France.
Zeller
Marianne
M
Jourdain
Patrick
P
Beaune
Jacques
J
Cambou
Jean-Pierre
JP
Vaisse
Bernard
B
Chamontin
Bernard
B
Cottin
Yves
Y
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001794:Blood Pressure; D003324:Coronary Artery Disease / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013610:Tachycardia / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents