Heart rate recovery in hypertensive patients: relationship with blood pressure control

Abstract

Delayed heart rate recovery (HRR) post treadmill exercise testing reflects autonomic dysfunction and is related to worse cardiovascular outcome. The present study compared HRR in normotensive subjects and hypertensive patients taking anti-hypertensive medications with controlled blood pressure (BP) and uncontrolled BP. A total of 279 consecutive patients with (n=140, HP) and without (n=139, N-HP) essential hypertension who were hospitalized in our department during May 2012 to March 2016 were included in this study. All subjects underwent treadmill exercise testing. Hypertensive patients were divided into controlled BP (n=88) and uncontrolled BP (n=52) groups according to their BP prior to treadmill exercise testing. Body mass index, triglyceride level and incidence of diabetes mellitus (DM) were significantly higher in the HP group than in the N-HP group, and HDL-c and HRR were significantly lower. Male gender, higher creatinine value and lower cholesterol and HDL-c were associated with lower HRR in the N-HP group, and higher triglyceride, lower LDL-c, and HDL-c were associated with lower HRR in the HP group. More frequent, ⩾3, antihypertensive drug use, less monotherapy use and high incidence of smokers and lower HRR were found in hypertensive patients with uncontrolled BP compared to hypertensive patients with controlled BP. The present results demonstrate that uncontrolled BP following antihypertensive medication is associated with lower HRR in hypertensive patients.

Value of Assessing Autonomic Nervous Function by Heart Rate Variability and Heart Rate Turbulence in Hypertensive Patients

“…Another study [11] reported that heart rate was increased and HRV was decreased in patients with refractory hypertension, suggesting that overactivation of the sympathetic nervous system might play an important role in patients with refractory hypertension. In a previous study [12], we demonstrated significant differences on autonomous balance in hypertensive patients with controlled and uncontrolled blood pressure. The present study showed that TS (reflecting vagus function triggered by endogenous ventricular premature beat [13]), rMSSD (reflecting vagus function by external environmental stimuli [14]), pNN50 (reflecting vagus function by external environmental stimuli [14]), VLF (reflecting sympathetic activity by external environmental stimuli [15]), LF (reflecting balance of sympathetic and vagal activity [14]), and HF (reflecting vagus function by external environmental stimuli [14]) values were significantly lower in hypertensive patients compared to N-HP patients, and TS, rMSSD, pNN50, VLF, LF, and HF values were also significantly lower in hypertensive patients with uncontrolled blood pressure compared to hypertensive patients with controlled blood pressure.…”

Impact of blood glucose control on sympathetic and vagus nerve functional status in patients with type 2 diabetes mellitus

“…Previous report described delayed HRR and abnormal HRV in DM patients [2,19]. Reduced HRR reflected impaired vagal functional status after exercise [23]. SDNN reflects total sympathetic and vagal functional status [9].…”

“…Treadmill exercise testing was performed according to the exercise test guideline of the American College of Cardiology/American Heart Association [22] with GE T2100 treadmill system (General Electric Company, Boston, USA) as previously described [23]. Briefly, Bruce exercise plan was used and all subjects achieved submaximal goal heart rate [(220-age) * 0.85].…”

“…Previous studies showed that HRR or HRV values could be significantly affected by beta-blockers use, hypertension and CAD [23,30,31]. In our study, multivariable logistic regression analysis demonstrated that lower HRR and HRV values were risk factors for DM, and lower SDNN, SDANN and VLF values were risk factors for poor glycemic control among DM patients after adjusting for gender, age and beta-blocker use in model 1, and after adjusting for gender, age, beta-blocker use, coronary artery disease and hypertension in model 2.…”

Increasing Age, Diabetes Mellitus and Beta Blocker Influence Heart Rate Recovery Values in Patients Undergoing Exercise Treadmill Test

“…9 More hypertension in the abnormal HRR group was in accordance with studies that reported hypertension was more common in the abnormal group. 11 More smoking in the normal HRR group. This result contrasts with studies reported more smoking in the abnormal HRR group.…”