title: Usefulness of heart rate to predict cardiac events in treated patients with high-risk systemic hypertension.
abstract: A high heart rate (HR) predicts future cardiovascular events. We explored the predictive value of HR in patients with high-risk hypertension and examined whether blood pressure reduction modifies this association. The participants were 15,193 patients with hypertension enrolled in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial and followed up for 5 years. The HR was assessed from electrocardiographic recordings obtained annually throughout the study period. The primary end point was the interval to cardiac events. After adjustment for confounders, the hazard ratio of the composite cardiac primary end point for a 10-beats/min of the baseline HR increment was 1.16 (95% confidence interval 1.12 to 1.20). Compared to the lowest HR quintile, the adjusted hazard ratio in the highest quintile was 1.73 (95% confidence interval 1.46 to 2.04). Compared to the pooled lower quintiles of baseline HR, the annual incidence of primary end point in the top baseline quintile was greater in each of the 5 study years (all p <0.05). The adjusted hazard ratio for the primary end point in the highest in-trial HR heart rate quintile versus the lowest quintile was 1.53 (95% confidence interval 1.26 to 1.85). The incidence of primary end points in the highest in-trial HR group compared to the pooled 4 lower quintiles was 53% greater in patients with well-controlled blood pressure (p <0.001) and 34% greater in those with uncontrolled blood pressure (p = 0.002). In conclusion, an increased HR is a long-term predictor of cardiovascular events in patients with high-risk hypertension. This effect was not modified by good blood pressure control. It is not yet known whether a therapeutic reduction of HR would improve cardiovascular prognosis.
authors.affiliation: University of Michigan, Ann Arbor, USA. sjulius@umich.edu
authors.forename: Stevo
authors.initials: S
authors.lastname: Julius
authors.forename: Paolo
authors.initials: P
authors.lastname: Palatini
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.forename: Alberto
authors.initials: A
authors.lastname: Zanchetti
authors.forename: Michael A
authors.initials: MA
authors.lastname: Weber
authors.forename: Gordon T
authors.initials: GT
authors.lastname: McInnes
authors.forename: Hans R
authors.initials: HR
authors.lastname: Brunner
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: M Anthony
authors.initials: MA
authors.lastname: Schork
authors.forename: Tsushung A
authors.initials: TA
authors.lastname: Hua
authors.forename: Bjoern
authors.initials: B
authors.lastname: Holzhauer
authors.forename: Dion
authors.initials: D
authors.lastname: Zappe
authors.forename: Silja
authors.initials: S
authors.lastname: Majahalme
authors.forename: Kenneth
authors.initials: K
authors.lastname: Jamerson
authors.forename: Nevres
authors.initials: N
authors.lastname: Koylan
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000008:administration & dosage / Q000627:therapeutic use*; D000068838:Amlodipine, Valsartan Drug Combination; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001794:Blood Pressure; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004338:Drug Combinations; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013610:Tachycardia / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D013777:Tetrazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000068838:Amlodipine, Valsartan Drug Combination; D000959:Antihypertensive Agents; D004338:Drug Combinations; D013777:Tetrazoles; D017311:Amlodipine