Faculty Collaboration Database

Usefulness of heart rate to predict cardiac events in treated patients with high-risk systemic hypertension. Am J Cardiol 2012 Mar 01;109(5):685-92

Date

12/16/2011

Pubmed ID

22169130

DOI

10.1016/j.amjcard.2011.10.025

Scopus ID

2-s2.0-84857626451 (requires institutional sign-in at Scopus site)   118 Citations

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.

Author List

Julius S, Palatini P, Kjeldsen SE, Zanchetti A, Weber MA, McInnes GT, Brunner HR, Mancia G, Schork MA, Hua TA, Holzhauer B, Zappe D, Majahalme S, Jamerson K, Koylan N

Author

Silja Majahalme MD, PhD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Amlodipine
Amlodipine, Valsartan Drug Combination
Antihypertensive Agents
Blood Pressure
Dose-Response Relationship, Drug
Double-Blind Method
Drug Combinations
Electrocardiography
Female
Follow-Up Studies
Heart Rate
Humans
Hypertension
Incidence
Male
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Prospective Studies
Risk Factors
Survival Rate
Tachycardia
Tetrazoles
Time Factors
Treatment Outcome