Effect of Changing Heart Rate During Treatment of Hypertension on Incidence of Heart Failure
Abstract
An elevated heart rate (HR) at rest at baseline is associated with an increased risk of incident heart failure (HF) and with greater cardiovascular event rates in patients with chronic HF. However, despite the high attributable risk of hypertension for HF, whether the in-treatment HR predicts incident HF in patients with treated hypertension has not been evaluated. The HR was evaluated on annual electrocardiograms from 9,024 patients with hypertension without HF who were treated with losartan- or atenolol-based regimens. During a mean follow-up of 4.7 ± 1.1 years, HF developed in 285 patients (3.2%). On multivariate Cox analyses adjusted for randomized treatment, the baseline risk factors for HF, baseline and in-treatment blood pressure, QRS duration, and electrocardiographic left ventricular hypertrophy, a greater in-treatment HR predicted a 45% greater adjusted risk of new HF for every 10-beats/min increase in the HR (95% confidence interval [CI] 34% to 57%) or a 159% greater risk of HF in patients with the persistence or development of a HR of ≥84 beats/min (95% CI 88% to 257%). In contrast, with adjustment for the same covariates, the baseline HR as a continuous variable was a significantly less powerful predictor of new HF (hazard ratio 1.15 per 10 beats/min, 95% CI 1.03 to 1.28) and a baseline HR of ≥84 beats/min did not predict new HF (hazard ratio 1.00, 95% CI 0.63 to 1.58). In conclusion, a greater in-treatment HR on the serial electrocardiograms predicts a greater risk of incident HF during antihypertensive treatment, independent of the covariates, in patients with hypertension with electrocardiographic left ventricular hypertrophy. These findings support serial HR assessment to improve the risk stratification of patients with hypertension.
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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 [390]
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- Authors
- Okin, P. M., Kjeldsen, S. E., Julius, S., Hille, D. A., Dahlöf, B., & Devereux, R. B.
- Affiliations
- Weill Cornell Medicine (US)
- Oslo University Hospital (NO)
- University of Michigan (US)
- Merck & Co., Inc., Rahway, NJ, USA (United States) (US)
- Sahlgrenska University Hospital (SE)
- Corresponding author
- Okin, Peter M.
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2012-03
- Volume
- 109
- Issue
- 5
- Pages
- 699-704
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2067445736
- Cited by
- 24
- References
- 30
- Citations by year
- 2026: 1 · 2025: 1 · 2022: 2 · 2021: 1 · 2020: 4 · 2019: 3 · 2018: 2 · 2016: 1 · 2015: 2 · 2014: 3 · 2013: 1 · 2012: 3
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Merck
- 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 Failure Treatment and Management
- Keywords
- heart rate, hypertension, heart failure, incident heart failure, left ventricular hypertrophy, antihypertensive therapy, losartan, atenolol, risk stratification, QRS duration
- MeSH terms
- Aged, Antihypertensive Agents, Dose-Response Relationship, Drug, Double-Blind Method, Electrocardiography, Female, Follow-Up Studies, Heart Failure, Heart Rate, Humans, Hypertension, Male, Prognosis, Prospective Studies, Risk Factors, Incidence, Losartan
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