title: Resting heart rate is associated with renal disease outcomes in patients with vascular disease: results of the ONTARGET and TRANSCEND studies.
abstract: BACKGROUND
  Resting heart rate (RHR) is associated with cardiovascular disease outcomes in high-risk patients. It is not known whether RHR is predictive of renal outcomes such as albuminuria, end-stage renal disease (ESRD) or doubling of creatinine. We evaluated whether RHR could predict renal endpoints in patients at a high risk of cardiovascular disease. We also tested the effects of RHR at different levels of systolic blood pressure (SBP).
  
  
  METHODS
  We analysed data from 28 757 patients in the ONTARGET and TRANSCEND trials. RHR and SBP were available for a mean of 4.9 ± 0.4 visits (range 3-5) within the first 2 years of the studies. Albuminuria was determined at baseline, at 2 years and at study end.
  
  
  RESULTS
  Mean RHR was predictive of incident micro-albuminuria [hazard ratio (HR) for RHR ≥80 vs. <60 beats min(-1) 1.49, 95% confidence interval (CI) 1.29-1.71, P < 0.0001], incident macro-albuminuria (HR 1.84, 95% CI 1.39-2.42, P < 0.0001), doubling of creatinine (HR 1.47, 95% CI 1.00-2.17, P = 0.050) and ESRD (HR 1.78, 95% CI 1.00-3.16, P = 0.050), and the combined renal end-point (HR 1.51, 95% CI 1.32-1.74, P < 0.0001). Associations were robust at SBPs from <120 to ≥150 mmHg, with the lowest risk at a SBP of 130-140 mmHg.
  
  
  CONCLUSIONS
  Resting heart rate is a potent predictor of these renal outcomes, as well as their combination, in patients with cardiovascular disease. RHR at all SBP levels should be considered as a possible renal disease risk predictor and should be investigated as a treatment target with RHR-reducing agents.
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Böhm
authors.affiliation: Boehringer Ingelheim, Ingelheim, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Schumacher
authors.affiliation: Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany.
authors.forename: R E
authors.initials: RE
authors.lastname: Schmieder
authors.affiliation: Department of Nephrology and Hypertension, Klinikum Schwabing, Munich, Germany.
authors.forename: J F E
authors.initials: JF
authors.lastname: Mann
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Teo
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Lonn
authors.affiliation: Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, UK.
authors.forename: P
authors.initials: P
authors.lastname: Sleight
authors.affiliation: IRCCS Istituto Auxologico Italiano, University of Milano-Bicocca, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Mancia
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Linz
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Mahfoud
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Ukena
authors.affiliation: Hatter Institute for Cardiovascular Research in Africa and IIDMM, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: K
authors.initials: K
authors.lastname: Sliwa
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: G
authors.initials: G
authors.lastname: Bakris
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000503:physiopathology*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000150:complications / Q000503:physiopathology*; D003404:Creatinine / Q000097:blood; D005260:Female; D006339:Heart Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology*; D008297:Male; D011379:Prognosis; D012307:Risk Factors
chemical_list: D003404:Creatinine
keywords: cardiovascular prevention; heart rate; high cardiovascular disease risk; hypertension; renal function