Office and 24-hour heart rate and target organ damage in hypertensive patients

BMC Cardiovascular Disorders

Luis García-Ortiz¹  Cristina Agudo-Conde¹  Emiliano Rodríguez-Sánchez¹  Maria C Patino-Alonso²  José I Recio-Rodríguez¹  Manuel A Gómez-Marcos¹  Ángel García-García¹ 

[1] Primary Care Research Unit, La Alamedilla Health Center. REDIAPP. IBSAL.SACyL, Salamanca, Spain;Statistics Department, University of Salamanca, Salamanca, Spain

关键词: Kidney disease;    left ventricular;    Hypertrophy;    Carotid arteries;    ambulatory;    Blood pressure monitoring;    Hypertension;    Heart rate;   

Others  :  1085195
DOI  :  10.1186/1471-2261-12-19

 received in 2011-11-25, accepted in 2012-03-22,  发布年份 2012

【 摘 要 】

Background

We investigated the association between heart rate and its variability with the parameters that assess vascular, renal and cardiac target organ damage.

Methods

A cross-sectional study was performed including a consecutive sample of 360 hypertensive patients without heart rate lowering drugs (aged 56 ± 11 years, 64.2% male). Heart rate (HR) and its standard deviation (HRV) in clinical and 24-hour ambulatory monitoring were evaluated. Renal damage was assessed by glomerular filtration rate and albumin/creatinine ratio; vascular damage by carotid intima-media thickness and ankle/brachial index; and cardiac damage by the Cornell voltage-duration product and left ventricular mass index.

Results

There was a positive correlation between ambulatory, but not clinical, heart rate and its standard deviation with glomerular filtration rate, and a negative correlation with carotid intima-media thickness, and night/day ratio of systolic and diastolic blood pressure. There was no correlation with albumin/creatinine ratio, ankle/brachial index, Cornell voltage-duration product or left ventricular mass index. In the multiple linear regression analysis, after adjusting for age, the association of glomerular filtration rate and intima-media thickness with ambulatory heart rate and its standard deviation was lost. According to the logistic regression analysis, the predictors of any target organ damage were age (OR = 1.034 and 1.033) and night/day systolic blood pressure ratio (OR = 1.425 and 1.512). Neither 24 HR nor 24 HRV reached statistical significance.

Conclusions

High ambulatory heart rate and its variability, but not clinical HR, are associated with decreased carotid intima-media thickness and a higher glomerular filtration rate, although this is lost after adjusting for age.

Trial Registration

ClinicalTrials.gov: NCT01325064

【 授权许可】

   
2012 García-García et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Kannel WB, Kannel C, Paffenbarger RS Jr, Cupples LA: Heart rate and cardiovascular mortality: the Framingham Study. Am Heart J 1987, 113(6):1489-1494.
• [2]Fox K, Ford I, Steg PG, Tendera M, Robertson M, Ferrari R, investigators B: Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial. Lancet 2008, 372(9641):817-821.
• [3]King DE, Everett CJ, Mainous AG, Liszka HA: Long-term prognostic value of resting heart rate in subjects with prehypertension. Am J Hypertens 2006, 19(8):796-800.
• [4]Bangalore S, Sawhney S, Messerli FH: Relation of beta-blocker-induced heart rate lowering and cardioprotection in hypertension. J Am Coll Cardiol 2008, 52(18):1482-1489.
• [5]Albaladejo P, Copie X, Boutouyrie P, Laloux B, Declere AD, Smulyan H, Benetos A: Heart rate, arterial stiffness, and wave reflections in paced patients. Hypertension 2001, 38(4):949-952.
• [6]Palatini P, Thijs L, Staessen JA, Fagard RH, Bulpitt CJ, Clement DL, de Leeuw PW, Jaaskivi M, Leonetti G, Nachev C, et al.: Predictive value of clinic and ambulatory heart rate for mortality in elderly subjects with systolic hypertension. Arch Intern Med 2002, 162(20):2313-2321.
• [7]Thomas F, Bean K, Provost JC, Guize L, Benetos A: Combined effects of heart rate and pulse pressure on cardiovascular mortality according to age. J Hypertens 2001, 19(5):863-869.
• [8]Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, et al.: 2007 Guidelines for the management of arterial hypertension: The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007, 25(6):1105-1187.
• [9]Jouven X, Empana JP, Schwartz PJ, Desnos M, Courbon D, Ducimetiere P: Heart-rate profile during exercise as a predictor of sudden death. N Engl J Med 2005, 352(19):1951-1958.
• [10]Rogowski O, Shapira I, Shirom A, Melamed S, Toker S, Berliner S: Heart rate and microinflammation in men: a relevant atherothrombotic link. Heart 2007, 93(8):940-944.
• [11]Singh RB, Cornelissen G, Weydahl A, Schwartzkopff O, Katinas G, Otsuka K, Watanabe Y, Yano S, Mori H, Ichimaru Y, et al.: Circadian heart rate and blood pressure variability considered for research and patient care. Int J Cardiol 2003, 87(1):9-28.
• [12]Ramirez-Villegas JFL-EE, Ramirez-Moreno DF, Calvo-Echeverry PC, Agredo-Rodriguez W: Heart rate variability dynamics for the prognosis of cardiovascular risk. PLoS One 2011, 6(2):e17060.
• [13]Earnest CP, Lavie CJ, Blair SN, Church TS: Heart rate variability characteristics in sedentary postmenopausal women following six months of exercise training: the DREW study. PLoS One 2008, 3(6):e2288.
• [14]Bohm M, Reil JC, Danchin N, Thoenes M, Bramlage P, Volpe M: Association of heart rate with microalbuminuria in cardiovascular risk patients: data from I-SEARCH. J Hypertens 2008, 26(1):18-25.
• [15]Inoue T, Iseki K, Iseki C, Ohya Y, Kinjo K, Takishita S: Heart rate as a risk factor for developing chronic kidney disease: longitudinal analysis of a screened cohort. Clin Exp Nephrol 2009, 13(5):487-493.
• [16]Cuspidi C, Valerio C, Meani S, Sala C, Esposito A, Masaidi M, Negri F, Giudici V, Zanchetti A, Mancia G: Ambulatory heart rate and target organ damage in never-treated essential hypertensives. J Hum Hypertens 2008, 22(2):89-95.
• [17]Facila L, Pallares V, Peset A, Perez M, Gil V, Montagud V, Bellido V, Bertomeu-Gonzalez V, Redon J: Twenty-four-hour ambulatory heart rate and organ damage in primary hypertension. Blood Press 2010, 19(2):104-109.
• [18]O'Brien E, Asmar R, Beilin L, Imai Y, Mancia G, Mengden T, Myers M, Padfield P, Palatini P, Parati G, et al.: Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertens 2005, 23(4):697-701.
• [19]O'Brien E, Petrie J, Littler W, de Swiet M, Padfield PL, O'Malley K, Jamieson M, Altman D, Bland M, Atkins N: The British Hypertension Society protocol for the evaluation of automated and semi-automated blood pressure measuring devices with special reference to ambulatory systems. J Hypertens 1990, 8(7):607-619.
• [20]Okin PM, Roman MJ, Devereux RB, Kligfield P: Electrocardiographic identification of increased left ventricular mass by simple voltage-duration products. J Am Coll Cardiol 1995, 25(2):417-423.
• [21]Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I, et al.: Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American society of echocardiography committee on standards, subcommittee on quantitation of two-dimensional echocardiograms. J Am Soc Echocardiogr 1989, 2(5):358-367.
• [22]Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N: Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986, 57(6):450-458.
• [23]Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, et al.: A new equation to estimate glomerular filtration rate. Ann Intern Med 2009, 150:604-612.
• [24]Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N, Csiba L, Desvarieux M, Ebrahim S, Fatar M, et al.: Mannheim carotid intima-media thickness consensus (2004-2006). An update on behalf of the Advisory Board of the 3d and 4th Watching the Risk Symposium, 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006. Cerebrovasc Dis 2007, 23(1):75-80.
• [25]Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, et al.: ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 2006, 113(11):e463-e654.
• [26]Barrios V, Escobar C, Bertomeu V, Murga N, de Pablo C, Asin E: High heart rate: more than a risk factor. Lessons from a clinical practice survey. Int J Cardiol 2009, 137(3):292-294.
• [27]Messerli FH, Bangalore S, Yao SS, Steinberg JS: Cardioprotection with beta-blockers: myths, facts and Pascal's wager. J Intern Med 2009, 266(3):232-241.
• [28]Hansen TW, Thijs L, Boggia J, Li Y, Kikuya M, Bjorklund-Bodegard K, Richart T, Ohkubo T, Jeppesen J, Torp-Pedersen C, et al.: Prognostic value of ambulatory heart rate revisited in 6928 subjects from 6 populations. Hypertension 2008, 52(2):229-235.
• [29]Gottsater A, Ahlgren AR, Taimour S, Sundkvist G: Decreased heart rate variability may predict the progression of carotid atherosclerosis in type 2 diabetes. Clin Auton Res 2006, 16(3):228-234.
• [30]Gautier C, Stine L, Jennings JR, Sutton-Tyrrell K, Muldoon MB, Kamarck TW, Kaplan GA, Salonen J, Manuck SB: Reduced low-frequency heart rate variability relates to greater intimal-medial thickness of the carotid wall in two samples. Coron Artery Dis 2007, 18(2):97-104.
• [31]Huikuri HV, Jokinen V, Syvanne M, Nieminen MS, Airaksinen KE, Ikaheimo MJ, Koistinen JM, Kauma H, Kesaniemi AY, Majahalme S, et al.: Heart rate variability and progression of coronary atherosclerosis. Arterioscler Thromb Vasc Biol 1999, 19(8):1979-1985.
• [32]Brotman DJ, Bash LD, Qayyum R, Crews D, Whitsel EA, Astor BC, Coresh J: Heart Rate Variability Predicts ESRD and CKD-Related Hospitalization. J Am Soc Nephrol 2010, 21(9):1560-1570.
• [33]Martini G, Rabbia F, Gastaldi L, Riva P, Sibona MP, Morra di Cella S, Chiandussi L, Veglio F: Heart rate variability and left ventricular diastolic function in patients with borderline hypertension with and without left ventricular hypertrophy. Clin Exp Hypertens 2001, 23(1-2):77-87.
• [34]Mancia G, Ulian L, Santucciu C, Parati G: Ambulatory blood pressure in hypertension with particular reference to the kidney. J Nephrol 1997, 10(4):198-202.