Usefulness of Heart Rate to Predict Cardiac Events in Treated Patients With High-Risk Systemic Hypertension
Open accessAbstract
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.
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In 2 post hoc analyses from large outcome trials, patients with heart rates >80 bpm had higher mortality.
“In 2 post hoc analyses from large outcome trials, patients with heart rates >80 bpm had higher mortality.389,390”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [389]
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- Authors
- Julius, S., Palatini, P., Kjeldsen, S. E., Zanchetti, A., Weber, M. A., McInnes, G. T., Brunner, H. R., Mancia, G., Schork, M. A., Hua, T. A., Holzhauer, B., Zappe, D., Majahalme, S., Jamerson, K., & Koylan, N.
- Affiliations
- University of Michigan (US)
- University of Padua (IT)
- Oslo University Hospital (NO)
- University of Milan (IT)
- State University of New York (US)
- University of Glasgow (GB)
- University of Lausanne (CH)
- University of Milano-Bicocca (IT)
- Istanbul University (TR)
- Corresponding author
- Julius, Stevo
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2012-03
- Volume
- 109
- Issue
- 5
- Pages
- 685-692
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2168586084
- Cited by
- 179
- References
- 28
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 5 · 2023: 15 · 2022: 10 · 2021: 10 · 2020: 17 · 2019: 7 · 2018: 9 · 2017: 10 · 2016: 18 · 2015: 5 · 2014: 9 · 2013: 33 · 2012: 23
- FWCI
- 14.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- heart rate, high-risk hypertension, cardiovascular events, cardiac event prediction, blood pressure control, valsartan, antihypertensive therapy, VALUE trial, cardiovascular prognosis
- MeSH terms
- Amlodipine, Valsartan Drug Combination, Aged, Antihypertensive Agents, Blood Pressure, Dose-Response Relationship, Drug, Double-Blind Method, Drug Combinations, Electrocardiography, Female, Follow-Up Studies, Heart Rate, Humans, Hypertension, Male, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Factors, Tachycardia, Tetrazoles, Time Factors, Incidence, Survival Rate, Proportional Hazards Models, Treatment Outcome, Amlodipine
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