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Reproducibility of heart rate measured in the clinic and with 24-hour intermittent recorders
P Palatini1, M Winnicki, M Santonastaso
1Dipartimento di Medicina Clinica e Sperimentale, University of Padova, Italy. palatini@ux1.unipd.it
Insights
Ambulatory heart rate monitoring shows better reproducibility than office measurements in hypertensive patients. This 24-hour heart rate tracking may offer superior prognostic insights compared to traditional resting heart rate assessments.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Measurement
Background:
- Office blood pressure measurements can be influenced by patient anxiety (white-coat effect).
- Reproducibility of cardiovascular measurements is crucial for accurate diagnosis and prognosis.
- Hypertension and Ambulatory Recording Venetia Study (HARVEST) investigated cardiovascular parameters in hypertensive individuals.
Purpose of the Study:
- To compare the reproducibility of office versus 24-hour ambulatory heart rate measurements.
- To identify factors influencing heart rate measurement reproducibility in hypertensive subjects.
- To determine if ambulatory heart rate is a better prognostic indicator than office heart rate.
Main Methods:
- 839 hypertensive subjects from the HARVEST study underwent two 24-hour ambulatory heart rate recordings, separated by three months.
- Office heart rate measurements were also recorded.
- Reproducibility was assessed using various indices, and correlations with clinical factors were analyzed.
Main Results:
- Ambulatory heart rate measurements demonstrated superior reproducibility compared to office measurements.
- Reproducibility was highest for 24-hour recordings, followed by daytime, and lowest for night-time.
- Office heart rate reproducibility declined with higher heart rates (>85 bpm) and more severe office hypertension.
Conclusions:
- 24-hour ambulatory heart rate monitoring offers better reproducibility than traditional office-based measurements in hypertensive patients.
- Ambulatory heart rate may serve as a more reliable prognostic indicator than resting heart rate measured in a clinical setting.
- The white-coat effect significantly influences heart rate reproducibility, highlighting the value of ambulatory monitoring.
Abstract:
This study was undertaken to assess the reproducibility of office versus ambulatory heart rates in 839 hypertensive subjects participating in the Hypertension and Ambulatory Recording Venetia Study (HARVEST). A 24-hour heart rate was recorded twice; this procedure was repeated three months later. Reproducibility was better for ambulatory than for office measurement, and was greater for 24-hour than for daytime heart rate, and lowest for night-time heart rate. Reproducibility of office heart rate was impaired above 85 bpm, and was poorer in subjects with more severe office hypertension. A small but significant decrease in average daytime (-1 bpm, P < 0.0001) and virtually no change in night-time heart rate (-0.3 bpm, NS) were observed at repeat recording. Heart rate reproducibility indices were related to the extent of the heart rate and blood pressure white-coat effect, but did not vary according to age, gender, body mass index, day-night blood pressure difference, or alcohol or tobacco use. Results indicate that heart rate recorded over the 24 hours has a better reproducibility than office heart rate, and could thus be a better prognostic indicator than traditional measurement of resting heart rate in the hospital setting.