title: Masked tachycardia. A predictor of adverse outcome in hypertension.
abstract: The relative role of office heart rate (HR) and ambulatory HR for predicting major adverse cardiovascular events (MACEs) and mortality is not well known. Aim of this study was to investigate the association of white-coat tachycardia and masked tachycardia with MACE and mortality in hypertensive patients.
  
  
  
  We performed 24-h ambulatory blood pressure and HR monitoring in 7602 hypertensive patients (4165 men) aged 52 ± 16 years enrolled in six prospective studies in Italy, Japan, and Australia. Participants were divided into four groups: normal office and normal night-time HRs (N = 5238), white-coat tachycardia (N = 998), masked tachycardia (N = 796), and sustained tachycardia (N = 570). Median follow-up was 5.0 years.
  
  
  
  In age-and-sex-adjusted Cox model, using the normal HRs group as a reference, white-coat tachycardia was not a significant predictor of excess MACEs or all-cause death. In contrast, both masked tachycardia [hazard ratio, 95% confidence interval (CI); 1.40, 1.11-1.77] and sustained tachycardia (1.86, 1.44-2.40) were associated with risk of excess MACE. In addition, masked tachycardia (hazard ratio, 95% CI; 1.62, 1.14-2.29) but not sustained tachycardia (1.35, 0.83-2.19) was a significant predictor of excess mortality. These relationships held true in multivariable parsimonious Cox models including major risk factors. In these models, masked tachycardia remained an independent predictor of excess MACE (hazard ratio, 95% CI; 1.34, 1.06-1.71) and all-cause mortality (1.68, 1.18-2.41).
  
  
  
  The current study confirms that measurement of HR adds to the risk stratification for MACE and mortality and shows that an elevated night-time HR confers an increased mortality risk to hypertensive patients who have normal office HR.
authors.affiliation: aUniversity of Padova, Padua bUniversity of Perugia, Perugia, Italy cUniversity of Western Australia, Perth, Western Australia, Australia dJichi University, Shimotsuke, Tochigi eTohoku University, Sendai fTeikyo University School of Medicine, Tokyo, Japan gUniversity of Chieti, Chieti, Italy hColumbia University iStony Brook University, New York, New York, USA jFlinders University, Adelaide, South Australia, Australia kHospital of Assisi, Assisi, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Palatini
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Reboldi
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Beilin
authors.forename: Edoardo
authors.initials: E
authors.lastname: Casiglia
authors.forename: Kazuo
authors.initials: K
authors.lastname: Eguchi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Sante D
authors.initials: SD
authors.lastname: Pierdomenico
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schwartz
authors.forename: Lindon
authors.initials: L
authors.lastname: Wing
authors.forename: Paolo
authors.initials: P
authors.lastname: Verdecchia
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D001315:Australia; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D007558:Italy; D007564:Japan; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013610:Tachycardia / Q000150:complications / Q000208:ethnology / Q000503:physiopathology; D044465:White People