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Office versus ambulatory heart rate in the prediction of the cardiovascular risk
1Department of Clinical and Experimental Medicine, University of Padova, Italy.
Insights
Resting heart rate is linked to high blood pressure and metabolic issues. Ambulatory heart rate may be less predictive, but further studies are needed to clarify their roles in cardiovascular health.
Area of Science:
- Cardiology
- Clinical Physiology
Background:
- Elevated heart rate is associated with hypertension, metabolic syndrome, and atherosclerosis.
- Clinical resting heart rate measurements are variable and may not fully represent cardiovascular risk.
- Ambulatory heart rate monitoring offers potential for more precise measurement.
Purpose of the Study:
- To evaluate the predictive value of clinic versus ambulatory heart rate for cardiovascular outcomes.
- To investigate the relationship between different heart rate measurements and blood pressure/metabolic abnormalities.
- To explore the role of heart rate in the development of atherosclerosis and coronary lesion progression.
Main Methods:
- Comparison of clinic-measured resting heart rate with 24-hour ambulatory heart rate monitoring.
- Analysis of associations between heart rate parameters and blood pressure, metabolic abnormalities, and cardiovascular events.
- Review of existing data on heart rate variability and its correlation with clinical outcomes.
Main Results:
- Clinic heart rate shows associations with blood pressure and metabolic abnormalities, unlike ambulatory heart rate.
- Ambulatory heart rate's predictive value for cardiovascular morbidity appears lower than clinic heart rate.
- Minimum heart rate, not average 24-hour values, may predict coronary lesion progression post-myocardial infarction.
Conclusions:
- Clinic heart rate remains a significant predictor of cardiovascular risk despite its variability.
- Ambulatory heart rate monitoring requires further investigation to determine its clinical utility.
- Prospective studies measuring both clinic and ambulatory heart rates are essential to elucidate their distinct roles.
Abstract:
Numerous studies have shown that a high heart rate is associated with high blood pressure and various metabolic abnormalities, and that it is prospectively related to the development of hypertension and atherosclerosis. Almost all these data have been obtained from resting heart rate measured in the clinic, which is a highly variable clinical parameter. Ambulatory heart rate might afford greater precision of measurement than can be achieved using clinic measurement, as is suggested by recent data obtained in our laboratory. However, the lack of association of ambulatory heart rate with blood pressure and metabolic abnormalities suggests that it might be less predictive of cardiovascular morbidity than is clinic heart rate. A high heart rate might also induce the development of atherosclerotic lesions via hemodynamic disturbances. In this respect, heart rate recorded over the 24 h should be more representative of the whole-day arterial stress than are casual measurements. However, recent data indicate that the progression of coronary lesions in patients who have suffered myocardial infarction is predicted by the minimum heart rate rather than by average 24 h values. Only prospective studies based on the measurement both of clinic and of ambulatory hearft rates will clarify the respective roles of these two clinical entities.