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Visit-to-Visit Heart Rate Variability Is Positively Associated With the Risk of Adverse Cardiovascular Outcomes
Rong Zeng1, Zuoguang Wang2, Wenli Cheng1
1Centre of Hypertension, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Visit-to-visit heart rate variability (VVHRV) is linked to higher cardiovascular risks in older hypertensive patients. Intensive blood pressure control remains beneficial regardless of VVHRV levels.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Trials
Background:
- Previous studies indicate visit-to-visit heart rate variability (VVHRV) may increase cardiovascular event risk.
- The impact of VVHRV on the benefits of intensive blood pressure control was previously unknown.
Purpose of the Study:
- To assess the association between VVHRV and composite cardiovascular outcomes in elderly hypertensive patients.
- To evaluate if intensive blood pressure control benefits are consistent across varying VVHRV levels.
Main Methods:
- A post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) dataset.
- Multivariate Cox proportional hazard regressions were used to explore the relationship between VVHRV and composite cardiovascular outcomes.
- The primary endpoint was a composite of myocardial infarction, stroke, heart failure, and/or cardiovascular death.
Main Results:
- A positive association was found between VVHRV and composite cardiovascular outcomes in elderly hypertensive patients (HR 1.04 per 1 CV increment).
- Intensive blood pressure control demonstrated consistent benefits in preventing cardiovascular events across different VVHRV subgroups.
- No significant interactions were observed with other confounders.
Conclusions:
- VVHRV is associated with increased composite cardiovascular outcomes in elderly hypertensive individuals.
- Intensive blood pressure management benefits remain consistent regardless of VVHRV levels.
- VVHRV does not alter the effectiveness of intensive blood pressure control for cardiovascular event prevention.
Introduction:
Previous studies found visit-to-visit heart rate variability (VVHRV) may be positively associated with risks of several cardiovascular events, but whether VVHRV affected the benefit of intensive blood pressure control remained unknown. In this study, we assessed the risk of the composite cardiovascular outcomes associated with VVHRV among the older patients with hypertension and evaluated whether the benefit of intensive blood pressure control in the prevention of the composite cardiovascular outcomes was consistent in the context of elevated VVHRV.
Methods:
This was a post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). We explored the relationship between VVHRV and the composite cardiovascular outcomes by multivariate Cox proportional hazard regressions. The primary endpoint was the composite cardiovascular outcomes, same as SPRINT, defined as a composite of myocardial infarction, stroke, heart failure, and/or death from cardiovascular causes. We used multiple adjustment models for all regressions.
Results:
Nine thousand two hundred and fourty-seven patients from the SPRINT were included in our analysis. We found a positive association between VVHRV and the risk of composite cardiovascular outcomes among the elderly with hypertension. Per 1 CV increment in HRCV, the hazard ratio of the risk of composite cardiovascular outcomes was 1.04 (95CI: 1.03, 1.05) in the fully adjusted Model. The benefit of intensive blood pressure control in managing cardiovascular events was consistent in different VVHRV subgroups. There was no significant interaction in other confounders.
Conclusion:
We found the VVHRV was associated with the composite cardiovascular outcomes among the elderly with hypertension, intensive blood pressure control did not change the above association, and the benefits of intensive blood pressure management were consistent across different VVHRV groups.
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