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Nighttime hemodynamic phenotype. A novel risk factor for cardiovascular disease, especially heart failure: the
Kazuomi Kario1,2, Satoshi Hoshide3,4, Hiroyuki Mizuno3
1Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. kkario@jichi.ac.jp.
Insights
Disrupted nighttime heart rate patterns increase cardiovascular disease (CVD) and heart failure (HF) risk, independent of blood pressure dipping status. Targeting nighttime hemodynamics is crucial for effective antihypertensive strategies.
Area of Science:
- Cardiology
- Hypertension Research
- Sleep Medicine
Background:
- Nocturnal blood pressure (BP) patterns like non-dipping and rising are established cardiovascular disease (CVD) risk factors, including heart failure (HF).
- The independent risk posed by disrupted nocturnal heart rate patterns remains less understood.
- This study investigates the association between nighttime heart rate patterns and HF risk.
Purpose of the Study:
- To determine if nighttime heart rate is an independent risk factor for heart failure (HF).
- To evaluate the role of nighttime heart rate patterns alongside nighttime blood pressure (BP) phenotypes in CVD risk.
- To assess the additive and independent contributions of nocturnal heart rate and BP dipping to CVD and HF risk.
Main Methods:
- Prospective, nationwide study (Japan Ambulatory Blood Pressure Monitoring Prospective [JAMP] study) of 6,359 patients with CVD risk factors.
- 24-hour ambulatory BP monitoring at baseline, with annual follow-ups.
- Calculation of nocturnal heart rate dipping as a percentage, and analysis of its association with CVD and HF events, adjusted for BP parameters.
Main Results:
- A 10-beats/min increase in nighttime heart rate significantly elevated the risk of total CVD, stroke, and HF events by 36-47% (p < 0.005).
- Nocturnal heart rate dipping status independently predicted CVD and HF risk, irrespective of office and 24-h systolic BP and nocturnal BP dipping status (p < 0.001).
- Inclusion of nocturnal heart rate dipping patterns significantly improved the predictive model for HF (C-statistic 0.852).
Conclusions:
- Nighttime heart rate non-dipper and riser patterns are associated with increased CVD, particularly HF risk.
- These associations are independent and additive to nocturnal blood pressure dipping status.
- Antihypertensive strategies should consider targeting nighttime hemodynamics, including heart rate patterns.
Background:
Non-dipper and riser patterns of nocturnal blood pressure (BP) are risk factors for cardiovascular disease (CVD), including heart failure (HF). However, the risk associated with a disrupted nocturnal pattern of heart rate is not well known.
Objectives:
To investigate whether the nighttime heart rate is a risk factor for HF, alongside nighttime BP phenotype.
Methods:
The practitioner-based, nationwide, prospective Japan Ambulatory Blood Pressure Monitoring Prospective (JAMP) study included patients with ≥ 1 CVD risk factor but without symptomatic CVD at baseline. All patients underwent 24-h ambulatory BP monitoring at baseline and were followed annually. Nocturnal heart rate dipping (%) was calculated as 100•[1 - nighttime/daytime heart rate].
Results:
During a mean 4.5 years' follow-up in 6,359 patients (mean age 68.6 years), there were 306 CVD events (119 stroke, 99 coronary artery disease, and 88 HF). A 10-beats/min increase in nighttime heart rate was significantly associated with a 36-47% increase in the risk of total CVD, stroke and HF events independently of office SBP and nighttime SBP (all p < 0.005). The CVD and HF risk associated with nocturnal heart rate dipping status was independent of office and 24-h systolic BP and nocturnal BP dipping status (p < 0.001). Performance of the final model for predicting HF including BP parameters was significantly improved by the addition of nocturnal heart rate dipping patterns (p = 0.038; C-statistic 0.852).
Conclusion:
Nighttime non-dipper and riser patterns of heart rate were associated with CVD especially HF, independently and additively of nocturnal BP dipping status, indicating the importance of antihypertensive strategies targeting nighttime hemodynamics.
Clinical Trial Registration:
URL: https://www.umin.ac.jp/ctr/ ; Unique identifier: UMIN000020377.
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