December 3, 2021Frontiers in Cardiovascular MedicineOpen Access

Association Between Heart Rate and Major Adverse Cardiovascular Events Among 9,991 Hypertentive Patients: A Multicenter Retrospective Follow-Up Study

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Why the study?

The study was designed to assess the effect of baseline heart rate on major adverse cardiovascular events among hypertensive patients in China.

Does baseline heart rate predict major adverse cardiovascular events in hypertensive patients?

Structured PICO

Does baseline heart rate predict major adverse cardiovascular events in hypertensive patients?

Population

9,991 hypertensive patients treated with standard antihypertensive drugs in China

Intervention

Baseline heart rate <65 bpm, 65-69 bpm, 75-79 bpm, or ≥80 bpm

Comparator

Baseline heart rate 70-74 bpm

Outcome

Major adverse cardiovascular events (MACEs) during 24-month follow-upcomposite

There is a U-shaped correlation between baseline heart rate and MACE risk in hypertensive patients, with both low (<65 bpm) and high (≥80 bpm) heart rates associated with increased risk.

Implication

HR <65 or ≥80 bpm associated with higher MACE risk; hypothesis-generating for HR as modifiable target in hypertension.

Abstract

Objective: To assess the effect of heart rate at baseline on major adverse cardiovascular events (MACEs) among hypertensive patients in China. Methods: A multicenter retrospective study was conducted with a 24 month follow-up period. A total of 10,031 hypertensive patients treated with standard antihypertensive drugs were grouped according to their heart rate before treatment: <65 beats per min (bpm), 65–69 bpm, 70–74 bpm, 75–79 bpm, and ≥80 bpm. The occurrence of any of MACEs was as the endpoint event during the 24 month follow-up period. The effect of heart rate at baseline on MACEs was analyzed using univate and multivariable Cox proportional regression analyses, with hazard ratios (HRs) and 95% confidence intervals (CIs). The restricted cubic spline (RCS) model was used to fit the Cox proportional harzard model with 5 knots at the 5 th , 25 th , 50 th , 75 th , and 95 th percentiles of heart rate. Results: Totally 9,991 patients were finally enrolled with the mean systolic pressure (SBP)/diastolic pressure (DBP) of 130.59 ± 7.13/77.66 ± 5.99 mmHg at 24 month follow-up. The incidence of MACEs was 4.80% ( n = 480). After adjustment for age, gender, baseline blood pressure, alcohol drinking, smoking, hyperlipidemia, diabetes, coronary heart disease, cerebrovascular disease and antihypertensive drug use, patients with heart rate <65 bpm (HR = 1.450, 95% CI: 1.098–1.915) and ≥80 bpm (HR = 1.391, 95% CI: 1.056–11.832) showed 0.45 fold and 0.391 fold increases of MACE risks, compared with patients with heart rate of 70–74 bpm. Furthermore, MACE risks were increased by 86.0% and 65.4% in men, and 59.3% and 69.0% in elderly patients aged ≥65 years at heart rate <65 bpm or ≥80 bpm, respectively. We also found a non-liner U-shaped correlation between heart rate and the occurrence of MACEs. Conclusions: Heart rate might be an independent risk factor for MACEs in hypertensive patients. An appropriate range of heart rate control may offer guidance to hypertension treatment.