title: Predictive value of night-time heart rate for cardiovascular events in hypertension. The ABP-International study.
abstract: BACKGROUND
  Data from prospective cohort studies regarding the association between ambulatory heart rate (HR) and cardiovascular events (CVE) are conflicting.
  
  
  METHODS
  To investigate whether ambulatory HR predicts CVE in hypertension, we performed 24-hour ambulatory blood pressure and HR monitoring in 7600 hypertensive patients aged 52 ± 16 years from Italy, U.S.A., Japan, and Australia, included in the 'ABP-International' registry. All were untreated at baseline examination. Standardized hazard ratios for ambulatory HRs were computed, stratifying for cohort, and adjusting for age, gender, blood pressure, smoking, diabetes, serum total cholesterol and serum creatinine.
  
  
  RESULTS
  During a median follow-up of 5.0 years there were 639 fatal and nonfatal CVE. In a multivariable Cox model, night-time HR predicted fatal combined with nonfatal CVE more closely than 24h HR (p=0.007 and =0.03, respectively). Daytime HR and the night:day HR ratio were not associated with CVE (p=0.07 and =0.18, respectively). The hazard ratio of the fatal combined with nonfatal CVE for a 10-beats/min increment of the night-time HR was 1.13 (95% CI, 1.04-1.22). This relationship remained significant when subjects taking beta-blockers during the follow-up (hazard ratio, 1.15; 95% CI, 1.05-1.25) or subjects who had an event within 5 years after enrollment (hazard ratio, 1.23; 95% CI, 1.05-1.45) were excluded from analysis.
  
  
  CONCLUSIONS
  At variance with previous data obtained from general populations, ambulatory HR added to the risk stratification for fatal combined with nonfatal CVE in the hypertensive patients from the ABP-International study. Night-time HR was a better predictor of CVE than daytime HR.
authors: University of Padova, Padua, Italy. Electronic address: palatini@unipd.it.
authors: Paolo
authors: P
authors: Palatini
authors: Gianpaolo
authors: G
authors: Reboldi
authors: Lawrence J
authors: LJ
authors: Beilin
authors: Kazuo
authors: K
authors: Eguchi
authors: Yutaka
authors: Y
authors: Imai
authors: Kazuomi
authors: K
authors: Kario
authors: Takayoshi
authors: T
authors: Ohkubo
authors: Sante D
authors: SD
authors: Pierdomenico
authors: Francesca
authors: F
authors: Saladini
authors: Joseph E
authors: JE
authors: Schwartz
authors: Lindon
authors: L
authors: Wing
authors: Paolo
authors: P
authors: Verdecchia
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods / Q000592:standards*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D038622:Internationality; D007558:Italy / Q000453:epidemiology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D014481:United States / Q000453:epidemiology
keywords: Ambulatory; Cardiovascular; Events; Heart rate; Hypertension; Sleep
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