title: Heart rate and heart rate variability in resistant versus controlled hypertension and in true versus white-coat resistance.
abstract: Sympathetic nervous system has an important role in resistant hypertension. Heart rate (HR) is a marker of sympathetic activity, but its association with resistant hypertension has not been assessed. We aimed to evaluate differences in HR values and variability between resistant and controlled patients and between true and white-coat resistant hypertensives (RHs). We compared office and ambulatory HR, nocturnal dip and s.d. in 14,627 RHs versus 11,951 controlled patients (on ⩽ 3 drugs) and in 8730 true (24 h blood pressure (BP) ⩾ 130 and/or 80 mm Hg) versus 4825 white-coat (24-h BP < 130/80 mm Hg) RHs. After adjusting for age, gender, body mass index, diabetes status and beta blocker use, HR values and variability were significantly elevated in resistant versus controlled patients and in true versus white-coat RHs. In logistic regression models, after adjustment for confounders, office HR (odds ratio for each increase in tertile: 1.337; 95% confidence interval: 1.287-1.388; P < 0.001), nocturnal dip (0.958; 0.918-0.999; P = 0.035) and night time s.d. (1.115; 1.057-1.177; P = 0.013) were all significantly associated with the presence of resistant hypertension. Moreover, night time HR (1.160; 1.065-1.265; P < 0.001), nocturnal dip (0.876; 0.830-0.925; P < 0.001) and 24-h s.d. (1.148; 1.092-1.207; P < 0.001) were all significantly associated with true resistant hypertension. In conclusion, both increased HR and variability are associated with resistant hypertension and with true resistance. These suggest the involvement of the sympathetic nervous system in the development of resistance to antihypertensive treatment.
authors.affiliation: Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Terrassa, Spain.
authors.forename: A
authors.initials: A
authors.lastname: de la Sierra
authors.affiliation: Division of cardiovascular disease, University of Alabama, Birmingham, AL, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Calhoun
authors.affiliation: CAP la Mina, University of Barcelona, San Adrian del Besos, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Vinyoles
authors.affiliation: Department of Preventive Medicine and Public Health, Autonomous University, Madrid, Spain.
authors.forename: J R
authors.initials: JR
authors.lastname: Banegas
authors.affiliation: Department of Preventive Medicine and Public Health, Autonomous University, Madrid, Spain.
authors.forename: J J
authors.initials: JJ
authors.lastname: de la Cruz
authors.affiliation: Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Gorostidi
authors.affiliation: Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain.
authors.forename: J
authors.identifier: 0000000346779526
authors.initials: J
authors.lastname: Segura
authors.affiliation: Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain.
authors.forename: L M
authors.initials: LM
authors.lastname: Ruilope
mesh_terms: D004351:Drug Resistance; D005260:Female; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D059466:White Coat Hypertension / Q000503:physiopathology*