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Long-term prognostic value of resting heart rate in subjects with prehypertension
Dana E King1, Charles J Everett, Arch G Mainous
1Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA. kingde@musc.edu <kingde@musc.edu>
Insights
Elevated resting heart rate increases cardiovascular risk in individuals with prehypertension, contributing to higher mortality and coronary heart disease (CHD) risk. This easily measured factor can help stratify risk in this population.
Area of Science:
- Cardiovascular Medicine
- Preventive Cardiology
- Epidemiology
Background:
- Elevated resting heart rate is a known cardiovascular risk factor in hypertension.
- The impact of elevated resting heart rate on cardiovascular risk in prehypertension is not well-established.
Purpose of the Study:
- To investigate whether elevated resting heart rate contributes to increased coronary heart disease (CHD) risk in individuals with prehypertension.
Main Methods:
- Analysis of 3275 participants (aged 45-64) from the Atherosclerosis Risk in Communities (ARIC) study with a 10.1-year follow-up.
- Primary outcomes assessed were CHD incidence and all-cause mortality.
Main Results:
- Individuals with prehypertension and elevated resting heart rate showed a 50% higher all-cause mortality (HR 1.50) and a 49% higher CHD risk (HR 1.49).
- Adjusted analyses indicated elevated resting heart rate remained a significant risk factor for CHD in women (aHR 2.18) but not in men.
- Risk remained significant after controlling for multiple cardiovascular risk factors.
Conclusions:
- Resting heart rate is a readily accessible clinical tool.
- It can aid in stratifying coronary heart disease and mortality risk among individuals with prehypertension.
Background:
Increased resting heart rate increases cardiovascular risk in individuals with hypertension. The extent to which such risk extends to people with prehypertension is not known. The purpose of this study was to determine whether elevated resting heart rate contributes to increased coronary heart disease (CHD) risk in people with prehypertension.
Methods:
The cohort for the current study consisted of 3275 persons from the Atherosclerosis Risk in Communities (ARIC) study, 45 to 64 years old in 1986 to 1989, with a mean follow-up of 10.1 years. The primary outcomes were CHD and all-cause mortality.
Results:
Individuals with prehypertension and elevated resting heart rate had 50% higher all-cause mortality than people with prehypertension and lower resting heart rate (hazard ratio [HR] 1.50, 95% confidence interval [CI] 1.0-2.15), which was essentially unchanged after controlling for age, ethnicity, gender, diabetes, smoking status, LDL-cholesterol, exercise, and use of antilipemic agents (P < .01). Similarly, in unadjusted analyses, CHD risk was 49% higher for people with increased heart rate (HR 1.49, 95% CI 1.03-2.14). In adjusted analyses, elevated resting heart rate remained a factor in increased risk of CHD in women (adjusted HR 2.18, 95% CI 1.08-4.42), but not in men.
Conclusions:
Resting heart rate is an easily accessible tool that may be helpful for stratifying CHD and mortality risk in people with prehypertension.
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