The link between elevated long-term resting heart rate and SBP variability for all-cause mortality

Resting heart rate (RHR) and SBP are important risk markers for all-cause mortality. However, the link between increased RHR and SBP for all causes of death remained unclear. We investigated the link between an increased visit-to-visit variation of RHR and SBP for risk of all-cause mortality in the general population.

We examined long-term visit-to-visit variation of RHR and blood pressure among 46 751 residents of Tangshan city, China (mean age: 52.58 ± 11.64 years; 78% men). Cox proportional hazard model was used to estimate the hazard ratios and 95% confidence interval (CI) adjusting for clinical characteristics assessed at the last examination (2010-2011).

A total of 1667 deaths were recorded over 4.97 ± 0.69 years follow-up. A rise in 1 SD of heart rate (4 bpm) was associated with an increased risk of death among the participants in third and fourth quartile of SBP-SD in the subgroups of general population [hazard ratio (95% CI) = 1.10 (1.03-1.67) and 1.16 (1.03-1.30), respectively], men [hazard ratio (95% CI) = 1.10 (1.02-1.17) and 1.16 (1.03-1.30), respectively], and participants under 65 years of age [hazard ratio (95% CI) = 1.16 (1.02-1.33) and 1.20 (1.03-1.39), respectively]. Similarly, 1-SD increase of SBP (7 mmHg) was associated with an increased risk of death among the participants in the highest quartiles of RHR-SD in the subgroups of the general population, men, and under 65 years of age.

An elevated long-term SBP variability combined with an increased RHR variability or vice versa may amplify the risk of all-cause mortality in general population, as well as in men and middle-age group.