Aladin Amer I, Al Rifai Mahmoud, Rasool Shereen H, Keteyian Steven J, Brawner Clinton A, Michos Erin D, Blaha Michael J, Al-Mallah Mouaz H, McEvoy John W
Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA;
Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA;
Am J Hypertens. 2016 Feb;29(2):251-7. doi: 10.1093/ajh/hpv095. Epub 2015 Jun 25.
Given that sympathetic tone is associated with hypertension, we sought to determine whether resting heart rate (RHR), as a surrogate for cardiac autonomic function, was associated with incident hypertension.
We analyzed 21,873 individuals without a history of hypertension who underwent a clinically indicated exercise stress test. Baseline RHR was assessed prior to testing and was categorized as <70, 70-85, and >85 beats-per-minute (bpm). Incident hypertension was defined by subsequent diagnosis codes for new-onset hypertension from three or more encounters. We tested for effect modification by age (<60 vs. ≥60 years), sex, race, and history of coronary heart disease (CHD).
Mean (±SD) age was 49 (±12) years, 55% were men and 21% were Black. Compared to the lowest RHR (<70 bpm) category, patients in the highest category (>85 bpm) were younger, more likely to be female, heavier, diabetic, and achieve lower metabolic equivalents (METS). Over a median of 4 years follow-up, there were 8,179 cases of incident hypertension. Compared to RHR <70 bpm, persons with RHR >85 bpm had increased risk of hypertension after adjustment for CHD risk factors, baseline blood pressure (BP), and METS (hazard ratio = 1.15 (95% confidence interval 1.08-1.23)). Age was an effect modifier (interaction P = 0.02), whereas sex, race, and CHD were not. In age-stratified analyses the relationship remained significant only in those younger than 60 years.
Elevated RHR is an independent risk factor for incident hypertension, particularly in younger persons. Whether lifestyle modification or other strategies to reduce RHR can prevent incident hypertension in high-risk individuals warrants further study.
鉴于交感神经张力与高血压相关，我们试图确定静息心率（RHR）作为心脏自主神经功能的替代指标是否与高血压发病相关。
我们分析了21873名无高血压病史且接受了临床指示运动应激试验的个体。在测试前评估基线RHR，并将其分类为每分钟<70次、70 - 85次和>85次心跳（bpm）。高血压发病通过三次或更多次就诊时新发高血压的后续诊断编码来定义。我们测试了年龄（<60岁与≥60岁）、性别、种族和冠心病（CHD）病史对结果的影响。
平均（±标准差）年龄为49（±12）岁，55%为男性，21%为黑人。与最低RHR（<70 bpm）类别相比，最高类别（>85 bpm）的患者更年轻、更可能为女性、体重更重、患有糖尿病且代谢当量（METS）更低。在中位4年的随访中，有8179例高血压发病病例。与RHR<70 bpm相比，在调整了CHD危险因素、基线血压（BP）和METS后，RHR>85 bpm的人患高血压的风险增加（风险比 = 1.15（95%置信区间1.08 - 1.23））。年龄是一个效应修饰因素（交互P = 0.02），而性别、种族和CHD则不是。在按年龄分层的分析中，这种关系仅在60岁以下的人群中仍然显著。
RHR升高是高血压发病的独立危险因素，尤其是在年轻人中。生活方式改变或其他降低RHR的策略是否能预防高危个体的高血压发病值得进一步研究。
