Prognostic Value of Ambulatory Heart Rate Revisited in 6928 Subjects From 6 Populations

Hansen, Tine W.; Thijs, Lutgarde; Boggia, José; Li, Yan; Kikuya, Masahiro; Björklund-Bodegård, Kristina; Richart, Tom; Ohkubo, Takayoshi; Jeppesen, Jørgen; Torp‐Pedersen, Christian; Lind, Lars; Sandoya, Edgardo; Imai, Yutaka; Wang, Ji‐Guang; Ibsen, Hans; O’Brien, Eoin; Staessen, Jan A.

doi:10.1161/hypertensionaha.108.113191

Cited by 87 publications

(71 citation statements)

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“…1,[13][14][15] Studies were eligible for inclusion if they involved a random population sample, if baseline information on ambulatory blood pressure and cardiovascular risk factors was available, and if the subsequent follow-up included fatal and nonfatal outcomes. At the time of writing this report, the International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcome included prospective studies from 11 centers (11 785 subjects).…”

Section: Study Populationmentioning

confidence: 99%

Prognostic Value of Reading-to-Reading Blood Pressure Variability Over 24 Hours in 8938 Subjects From 11 Populations

et al. 2010

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Abstract-In previous studies, of which several were underpowered, the relation between cardiovascular outcome and blood pressure (BP) variability was inconsistent. We followed health outcomes in 8938 subjects (mean age: 53.0 years; 46.8% women) randomly recruited from 11 populations. At baseline, we assessed BP variability from the SD and average real variability in 24-hour ambulatory BP recordings. We computed standardized hazard ratios (HRs) while stratifying by cohort and adjusting for 24-hour BP and other risk factors. Over 11.3 years (median), 1242 deaths (487 cardiovascular) occurred, and 1049, 577, 421, and 457 participants experienced a fatal or nonfatal cardiovascular, cardiac, or coronary event or a stroke.Higher diastolic average real variability in 24-hour ambulatory BP recordings predicted (PՅ0.03) total (HR: 1.14) and cardiovascular (HR: 1.21) mortality and all types of fatal combined with nonfatal end points (HR: Ն1.07) with the exception of cardiac and coronary events (HR: Յ1.02; PՆ0.58). Higher systolic average real variability in 24-hour ambulatory BP recordings predicted (PϽ0.05) total (HR: 1.11) and cardiovascular (HR: 1.16) mortality and all fatal combined with nonfatal end points (HR: Ն1.07), with the exception of cardiac and coronary events (HR: Յ1.03; PՆ0.54). SD predicted only total and cardiovascular mortality. While accounting for the 24-hour BP level, average real variability in 24-hour ambulatory BP recordings added Ͻ1% to the prediction of a cardiovascular event. Sensitivity analyses considering ethnicity, sex, age, previous cardiovascular disease, antihypertensive treatment, number of BP readings per recording, or the night:day BP ratio were confirmatory. In conclusion, in a large population cohort, which provided sufficient statistical power, BP variability assessed from 24-hour ambulatory recordings did not contribute much to risk stratification over and beyond 24-hour BP. (Hypertension. 2010;55:1049-1057.)Key Words: blood pressure variability Ⅲ ambulatory blood pressure Ⅲ population science Ⅲ risk factors Ⅲ epidemiology A mbulatory blood pressure monitoring not only provides information on the blood pressure level but on the diurnal changes in blood pressure as well. Blood pressure variability includes both short-term and circadian components, which can be estimated by the SD of the blood pressure values over a defined period of the day or by the night:day blood pressure ratio, respectively. We recently reported in Ͼ7000 subjects recruited from 6 populations on the prognos- Although the aforementioned analyses shed light on the association between outcome and long-term blood pressure variability, the predictive value of short-term reading-toreading blood pressure variability remains uncertain. Possible limitations of previous studies were a lack of statistical power, 2-5 selection of specific groups of patients, 5-7 categorization of variability by arbitrary cutoff points, 2,4,7-9 and sole reliance on fatal end points. 10,11 Moreover, various parameters can capture short-term b...

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Section: Study Populationmentioning

confidence: 99%

Prognostic Value of Reading-to-Reading Blood Pressure Variability Over 24 Hours in 8938 Subjects From 11 Populations

et al. 2010

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“…In this meta-analysis, the magnitude of association between resting heart rate and all-cause mortality was stronger than that with cardiovascular mortality, and this discrepancy can be expected because resting heart rate has also been found to be associated with noncardiovascular mortality. 28,34,44,51,54,69 One main concern lies in whether a high resting heart rate is an independent predictor, because higher heart rates coexist with traditional risk factors of cardiovascular disease and poor health status. [10][11][12][13]70 Overall, the association of resting heart rate with risk of all-cause and cardiovascular mortality is independent of traditional risk factors of cardiovascular disease, suggesting that resting heart rate is a predictor of mortality in the general population.…”

Section: Discussionmentioning

confidence: 99%

“…However, a J-shaped curve was also indicated by categorizing resting heart rate. 44,48,55 Because this is a meta-analysis focusing on the general population (i.e., excluding studies in disease-specific populations), patients with a very low resting heart rate are likely to be more physically fit. Therefore, more benefit could be anticipated for patients with a very low resting heart rate.…”

Section: Discussionmentioning

confidence: 99%

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Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis

Zhang

Shen

2015

CMAJ

239

167

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Interpretation: Higher resting heart rate was independently associated with increased risks of all-cause and cardiovascular mortality. This indicates that resting heart rate is a predictor of all-cause and cardiovascular mortality in the general population. Abstract Research E54CMAJ, February 16, 2016, 188(3) traditional risk factors of cardiovascular disease on the association of resting heart rate with risk of all-cause and cardiovascular mortality. Methods Literature search and selectionWe searched PubMed, Embase and MEDLINE from inception to Jan. 1, 2015, restricting the search to studies involving humans and published in English or Chinese. Details of the search strategy are shown in Appendix 1 (available at www.cmaj.ca/lookup/suppl/doi:10.1503/ cmaj.150535/-/DC1). We reviewed the reference lists from retrieved articles to search for further relevant studies. Studies were included if they met the following criteria: the study group was the general population (i.e., excluding studies in disease-specific populations); the exposure of interest was resting heart rate; the outcome of interest was all-cause or cardiovascular mortality; age-or multivariateadjusted relative risk estimates with 95% confidence intervals (CIs) were provided; and the study used a prospective design. If data were duplicated in more than 1 study, we included the study with the longest follow-up duration. Two investigators (D.Z. and X.S) independently conducted the literature search and selection.

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“…This issue has been observed in a large study of general population in which 24-hour HR was able to predict total and noncardiovascular mortality but not cardiovascular mortality or any of the fatal combined with nonfatal events. 17 Also in the Ohasama study, ambulatory HR predicted noncardiovascular disease mortality, but neither daytime nor nighttime HR predicted cardiovascular disease mortality. 18 Recently, the association between cardiovascular events and ambulatory HR was investigated in the ABPInternational registry.…”

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confidence: 94%

Heart Rate as a Marker of Cardiovascular Prognosis

Seravalle¹

2016

Hypertension Journal

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Although several studies have shown that elevated heart rate (HR) is a powerful, independent, and consistent predictor of cardiovascular events and all-cause mortality, it is still considered an epiphenomenon of a general disorder rather than an independent risk factor. Several questions regarding the clinical significance of a resting HR as marker of cardiovascular risk are still unanswered, rendering the inclusion of this hemodynamic variable in the list of cardiovascular risk factors problematic, at least for time being. This paper will examine which HR value better reflects the cardiovascular risk, the predictive power, the complex pathophysiological mechanisms underlying the relationship between HR and cardiovascular risk. It will evaluate whether HR should be considered a true risk factor for cardiovascular diseases or simply a marker of autonomic imbalance, and finally, it will consider the effects of HR reduction on cardiovascular morbidity.

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Prognostic Value of Ambulatory Heart Rate Revisited in 6928 Subjects From 6 Populations

Cited by 87 publications

References 43 publications

Prognostic Value of Reading-to-Reading Blood Pressure Variability Over 24 Hours in 8938 Subjects From 11 Populations

Prognostic Value of Reading-to-Reading Blood Pressure Variability Over 24 Hours in 8938 Subjects From 11 Populations

Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis

Heart Rate as a Marker of Cardiovascular Prognosis

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