Key result
Morning-to-evening pulse rate rise ≥3 bpm linked to ~5-point lower office BP control.
Why the study?
To investigate the determinants, interrelationship, and association with BP control of morning-to-evening changes in home blood pressure and pulse rate in treated hypertension.
Cross-Sectional (n=4,787)
Yes
Absolute Event Rate: 60.1% vs 65.5%
p-value: p=<0.001
In treated hypertensive patients, a morning-to-evening drop in home blood pressure is interrelated with a compensatory rise in pulse rate, and a more pronounced pulse rate increase is associated with poorer office blood pressure control.
May flag poorer office BP control; leaves open whether diurnal pulse monitoring aids hypertension management.
BACKGROUND: We investigated the morning-to-evening changes in home blood pressure (BP) and pulse rate for demographic and clinical determinants, interrelationship, and association with BP control in treated patients with hypertension. METHODS: We performed a cross-sectional analysis in patients (≥55 years of age) with hypertension, enrolled in a China nationwide registry on home BP monitoring between 2020 and 2025. Home BP was measured three times consecutively in the morning and evening, respectively, for seven consecutive days. The change was calculated by subtracting the BP and pulse rate values in the morning from those in the evening. RESULTS: The 4,787 participants had a mean (±SD) age of 66.1 (±7.5) years, and included 2,366 (49.4%) men. Overall, systolic/diastolic BP decreased from 129.1/80.6 mmHg in the morning to 127.2/78.7 mmHg in the evening by a mean change of -1.9 ± 7.8/-1.8 ± 4.7 mmHg. Pulse rate, however, increased from 70.5 beats/min in the morning to 73.7 beats/min in the evening by a mean change of +3.1 ± 5.8 beats/min. Adjusted analyses showed that the changes in pulse rate were negatively associated with those in both systolic (r = -0.20, 95% CI: -0.22 to -0.17) and diastolic BP (r = -0.12, 95% CI: -0.14 to -0.09). Patients with a change in pulse rate above the median (≥3.0 beats/min) had a lower control rate of office systolic/diastolic BP (60.1% vs. 65.5%, P < 0.001) than those with a change in pulse rate below the median. CONCLUSIONS: There were interrelated morning-to-evening changes in home BP and pulse rate, being a drop and rise, respectively.
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Zhu et al. (2025) conducted a cross-sectional in Hypertension (n=4,787). Morning-to-evening increase in home pulse rate ≥3.0 beats/min vs. Morning-to-evening increase in home pulse rate <3.0 beats/min was evaluated on Control rate of combined office systolic/diastolic blood pressure (<140/90 mmHg) (p=<0.001). An increase in home pulse rate from morning to evening of ≥3.0 beats/min was associated with a significantly lower control rate of combined office blood pressure compared to an increase of <3.0 beats/min (60.1% vs. 65.5%, p<0.001).
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