title: Resting heart rate pattern during follow-up and mortality in hypertensive patients.
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 >or=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.
authors.affiliation: British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Paul
authors.forename: Claire E
authors.initials: CE
authors.lastname: Hastie
authors.forename: Weiling S
authors.initials: WS
authors.lastname: Li
authors.forename: Craig
authors.initials: C
authors.lastname: Harrow
authors.forename: Scott
authors.initials: S
authors.lastname: Muir
authors.forename: John M C
authors.initials: JM
authors.lastname: Connell
authors.forename: Anna F
authors.initials: AF
authors.lastname: Dominiczak
authors.forename: Gordon T
authors.initials: GT
authors.lastname: McInnes
authors.forename: Sandosh
authors.initials: S
authors.lastname: Padmanabhan
mesh_terms: D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D012042:Registries; D012146:Rest; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents