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Severe obesity is independently associated with elevated 24-hour ambulatory heart rate in hypertensive outpatients

Giuliano Tocci1, Giulia Nardoianni1, Barbara Pala2

  • 1Division of Cardiology, Sant'Andrea Hospital, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, 00189, Italy.

Nutrition, Metabolism, and Cardiovascular Diseases : NMCD
|July 16, 2026
PubMed

Insights

Severe obesity in hypertensive patients is linked to higher heart rates (HR) throughout the day and night. This study highlights a distinct chronotropic profile associated with obesity in this population.

Area of Science:

  • Cardiology
  • Obesity Medicine
  • Hypertension Research

Background:

  • Elevated heart rate (HR) is a known cardiovascular risk factor.
  • The relationship between body mass index (BMI) and ambulatory HR in hypertensive patients is not fully understood.
  • Understanding this association is crucial for managing cardiovascular risk in this population.

Purpose of the Study:

  • To investigate the association between BMI and both office and ambulatory HR in hypertensive outpatients.
  • To explore heart rate variability (HRV) in relation to BMI in this cohort.
  • To characterize the ambulatory HR profile across different BMI strata.

Main Methods:

  • Retrospective observational study of 10,003 hypertensive outpatients undergoing office and ambulatory blood pressure monitoring (ABPM).
  • Patients stratified by BMI (<25, 25-29, 30-34, and ≥35 kg/m²).
  • HR assessed at office and during 24-h, daytime, and night-time periods; HRV estimated as coefficient of variation (CV%) of ambulatory HR. Multivariable models adjusted for confounders.

Main Results:

  • Increasing BMI showed a graded, significant rise in HR across all measurement settings (P < 0.001).
  • Patients with BMI ≥35 kg/m² had higher office HR (79.6 vs 75.7 bpm) and 24-h HR (76.7 vs 72.5 bpm) compared to normal-weight individuals.
  • These associations remained significant after multivariable adjustment and were consistent in treated and untreated patients; non-linear relationship observed between BMI and ambulatory HR.

Conclusions:

  • Severe obesity (BMI ≥35 kg/m²) is independently associated with elevated office and 24-h ambulatory HR in hypertensive outpatients.
  • This defines a distinct chronotropic phenotype in obese hypertensive individuals.
  • Ambulatory heart rate variability (HRV) alterations appear less pronounced compared to the HR elevation itself.
Abstract

Keywords:
Ambulatory blood pressure monitoringBeta-blockersCalcium channel blockersCardiovascular riskHeart rateHeart rate variabilityObesity

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