Palatini Paolo, Thijs Lutgarde, Staessen Jan A, Fagard Robert H, Bulpitt Christopher J, Clement Denis L, de Leeuw Peter W, Jaaskivi Matti, Leonetti Gastone, Nachev Choudomir, O'Brien Eoin T, Parati Gianfranco, Rodicio José L, Roman Elisabetta, Sarti Cinzia, Tuomilehto Jaakko
Clinica Medica 4, University of Padova, via Giustiniani 2, 35128 Padua, Italy.
Arch Intern Med. 2002 Nov 11;162(20):2313-21. doi: 10.1001/archinte.162.20.2313.
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.
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.
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.
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.
在欧洲收缩期高血压试验中，研究老年单纯收缩期高血压患者的诊室心率和动态心率与全因死亡、心血管死亡及非心血管死亡之间的关联。
共有4682例患者参与研究，其基线时常规测量的未治疗血压为收缩压160至219 mmHg，舒张压低于95 mmHg。诊室心率为3次就诊期间6次读数的平均值。807例受试者采用便携式间歇技术记录动态心率。
在服用安慰剂的2293名男性和女性中，基线诊室心率升高与全因、心血管和非心血管死亡率的预后较差呈正相关。心率高于79次/分钟（bpm）（最高五分位数）的受试者的死亡风险是心率低于或等于79 bpm的受试者的1.89倍（9５%置信区间，1.33-2.68 bpm）。在Cox回归分析中，死亡时间的预测因素为心率（P<0.001）、年龄（P<0.001）、血清肌酐水平（P = 0.001）、糖尿病的存在（P = 0.002）、既往心血管疾病（P = 0.01）、甘油三酯读数（P = 0.02）、吸烟（P = 0.04）和收缩压升高（P = 0.05），而总胆固醇水平在模型中无显著意义。在动态监测亚组中，诊室心率和动态心率可预测非心血管死亡，但不能预测心血管死亡。然而，在纳入诊室心率和动态心率的Cox回归分析中，仅诊室心率与非心血管死亡存在显著关联（P = 0.004）。在活性治疗组中，校正混杂因素后，诊室心率对死亡率的微弱预测能力消失。
在未治疗的老年单纯收缩期高血压患者中，诊室心率大于79 bpm是全因、心血管和非心血管死亡的重要预测因素。动态心率并未为诊室心率提供的预后信息增加额外价值。
