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Predictive Value of Clinic and Ambulatory Heart Rate for Mortality in Elderly Subjects With Systolic Hypertension
Paolo Palatini, MD;
Lutgarde Thijs, MSc;
Jan A. Staessen, MD;
Robert H. Fagard, MD;
Christopher J. Bulpitt, MD;
Denis L. Clement, MD;
Peter W. de Leeuw, MD;
Matti Jaaskivi, MD;
Gastone Leonetti, MD;
Choudomir Nachev, MD;
Eoin T. O'Brien, MD;
Gianfranco Parati, MD;
José L. Rodicio, MD;
Elisabetta Roman, MD;
Cinzia Sarti, MD;
Jaakko Tuomilehto, MD;
for the Systolic Hypertension in Europe (Syst-Eur) Trial Investigators
Arch Intern Med. 2002;162:2313-2321.
Objective To examine the association of clinic and ambulatory heart rate with total, cardiovascular, and noncardiovascular death in a cohort of elderly subjects with isolated systolic hypertension from the Systolic Hypertension in Europe Trial.
Methods A total of 4682 patients participated, whose untreated blood pressure on conventional measurement at baseline was 160 to 219 mm Hg systolic and lower than 95 mm Hg diastolic. Clinic heart rate was the mean of 6 readings during 3 visits. Ambulatory heart rate was recorded with a portable intermittent technique in 807 subjects.
Results Raised baseline clinic heart rate was positively associated with a worse prognosis for total, cardiovascular, and noncardiovascular mortality among the 2293 men and women taking placebo. Subjects with heart rates higher than 79 beats/min (bpm) (top quintile) had a 1.89 times greater risk of mortality than subjects with heart rate lower than or equal to 79 bpm (95% confidence interval, 1.33-2.68 bpm). In a Cox regression analysis, predictors of time to death were heart rate (P<.001), age (P<.001), serum creatinine level (P = .001), presence of diabetes (P = .002), previous cardiovascular disease (P = .01), triglyceride readings (P = .02), smoking (P = .04), and elevated systolic blood pressure (P = .05), while total cholesterol level was found to be nonsignificant in the model. In the ambulatory monitoring subgroup, clinic and ambulatory heart rates predicted noncardiovascular but not cardiovascular mortality. However, in a Cox regression analysis in which clinic and ambulatory heart rates were included, a significant association with noncardiovascular mortality was found only for clinic heart rate (P = .004). In the active treatment group, the weak predictive power of clinic heart rate for mortality disappeared after adjustment for confounders.
Conclusions In untreated older patients with isolated systolic hypertension, a clinic heart rate greater than 79 bpm was a significant predictor of all-cause, cardiovascular, and noncardiovascular mortality. Ambulatory heart rate did not add prognostic information to that provided by clinic heart rate.
From Clinica Medica 4, Universitá di Padova, Padua, Italy (Drs Palatini and Roman); the Study Coordinating Center, Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, University of Leuven, Leuven, Belgium (Ms Thijs and Drs Straessen and Fagard); Department of Cardiology and Angiology, Ghent University Hospital, Belgium (Dr Clement); Hypertension Unit, Beaumont Hospital, Dublin, Ireland (Dr O'Brien); Section Care of the Elderly, Imperial College of Medicine, Hammersmith Hospital, London, England (Dr Bulpitt); Afdeling Interne Geneeskunde, Universiteit Maastricht, Maastricht, the Netherlands (Dr de Leeuw); Department of Internal Medicine, Alexandrov's University Hospital, Sofia, Bulgaria (Dr Nachev); Department of Internal Medicine, Universitá di Milano-Bicocca, and S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (Drs Leonetti, Parati and Sarti); Hospital 12 de Octubre, Madrid, Spain (Dr Rodicio); and Department of Epidemiology and Health Promotion, National Public Health Institute and Department of Public Health, University of Helsinki, Helsinki, Finland (Drs Jaaskivi and Tuomilehto). A list of Syst-Eur Trial participants is available at http://www.kuleuven.ac.be/hypertension/systeur/index/htm (accessed August 14, 2002).
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