Resting Heart Rate and Cardiovascular Outcomes during Intensive and Standard Blood Pressure Reduction: An Analysis from SPRINT Trial

Abstract

The association between elevated resting heart rate (RHR) as a cardiovascular risk factor and lowering of systolic blood pressure (SBP) to currently recommended values remain unknown. Systolic Blood Pressure Intervention Trial (SPRINT) data obtained from the NHLBI were used to describe the relationship between RHR and SBP reduction to <120 mmHg compared to SBP reduction to <140 mmHg. The composite clinical endpoint (CE) was defined as myocardial infarction, acute coronary syndrome, decompensation of heart failure, stroke, or cardiovascular death. Increased RHR was associated with a higher CE risk compared with low RHR in both treatment arms. A more potent increase of risk for CE was observed in subjects who were allocated to the SBP < 120 mmHg treatment goal. A similar effect of intensive and standard blood pressure (BP) reduction (p for interaction, 0.826) was observed in subjects with RHR in the 5th quintile (hazard ratio, 0.78, with 95% confidence interval (CI), 0.55–1.11) and in other quintiles of baseline RHR (hazard ratio, 0.75, with 95% CI, 0.62–0.90). Lower in-trial than baseline RHR was associated with reduced CE risk (hazard ratio, 0.80, with 95% CI, 0.66–0.98). We concluded that elevated RHR remains an essential risk factor independent of SBP reduction.

Visit-to-Visit Heart Rate Variability Is Positively Associated With the Risk of Adverse Cardiovascular Outcomes

“…Both RHR and VVHRV were proven to be positively associated with the risk of cardiovascular outcomes. A sub-study of the SPRINT randomized controlled trial found that the increase in the risk of composite cardiovascular events toward elevated baseline RHR was more potent in hypertensive subjects received intensive blood pressure treatment, compared to those with standard blood pressure treatment ( 10 ). However, the effect of intensive blood pressure control on VVHRV remained unknown.…”

“…The Systolic Blood Pressure Intervention Trial (SPRINT) trial showed that intensive blood pressure control showed significant better cardiovascular outcomes, after which the American hypertension guideline quickly reduced the blood pressure target ( 8 , 9 ). Sobieraj et al reported a more potent increase in cardiovascular risk associated with higher RHR in the intensive blood pressure treatment than in the standard treatment group ( 10 ). However, whether long-term RHR variability affected the benefit of intensive blood pressure control remained unknown.…”

Effect of Renal Denervation for the Management of Heart Rate in Patients With Hypertension: A Systematic Review and Meta-Analysis

“…Heart rate (HR) is regulated by both sympathetic and parasympathetic nerves, with sympathetic overactivation causing an increase in HR and parasympathetic nerves acting in the opposite direction ( 7 ). Increased resting HR is associated with high cardiovascular morbidity and mortality ( 8 ). In a high-risk population where 75% had hypertension, increased HR is an independent risk factor for the development of heart failure ( 9 ).…”

Estrogen Metabolite 2-Methoxyestradiol Attenuates Blood Pressure in Hypertensive Rats by Downregulating Angiotensin Type 1 Receptor

“…Temporal changes in HR are also associated with mortality, heart attack, and stroke in the Atherosclerosis Risk in Communities Study ( Vazir et al, 2018 ). Additionally, the Systolic Blood Pressure in Intervention Trial indicated higher RHR increased cardiovascular risk ( Sobieraj et al, 2021 ). Therefore, overall suggestion of managing increasing RHR and BP is complex due to lack of clinical guidelines, although the LIFE study shows that increased RHR by 10 beats per minute increases cardiovascular mortality ( Okin et al, 2010 ).…”