Kimura Takahiro, Kikuya Masahiro, Asayama Kei, Tatsumi Yukako, Imai Yutaka, Ohkubo Takayoshi
Department of Hygiene and Public Health Teikyo University School of Medicine Tokyo Japan.
Fourth Department of Internal Medicine Mizonokuchi Hospital, Teikyo University School of Medicine Kawasaki Japan.
J Am Heart Assoc. 2024 Dec 17;13(24):e037292. doi: 10.1161/JAHA.124.037292. Epub 2024 Dec 14.
Although a high pulse rate assessed in the clinic office setting has been associated with an increased risk of cardiovascular disease and mortality, there are few studies assessing the prognostic ability of out-of-office pulse rate, particularly self-measured home pulse rate.
We investigated the prognostic ability of home pulse rate in 3022 patients with mild-to-moderate hypertension. During a median follow-up of 7.3 years, 72 patients died and 50 had major adverse cardiovascular events. For each 1 SD increase in pulse rate before treatment (9.4 beats per minute), the adjusted hazard ratio for all-cause mortality was 1.52 (95% CI, 1.24-1.92). For each 1 SD increase in pulse rate during the follow-up period (9.9 beats per minute), the adjusted hazard ratio was 1.70 (95% CI, 1.39-2.08). However, pulse rate was not significantly associated with major adverse cardiovascular events. When both home pulse rate and office pulse rate before treatment were included in a Cox model, only the home pulse rate significantly predicted all-cause mortality ( ≤0.019). Excluding the home pulse rate from the model led to a significant deterioration of the model fit statistic ( ≤0.020). The optimal cut-off values of home pulse rate in predicting all-cause mortality, determined by Youden's index from a receiver operator characteristic analysis, were 67.8 beats per minute at baseline and 66.4 beats per minute during follow-up.
In patients with mild-to-moderate hypertension, the pulse rate measured at home, both before and during antihypertensive treatment, was associated with mortality risk and has superior prognostic ability compared with office pulse rate. The accuracy of risk stratification may be improved by using a home pulse rate, which can be self-measured easily and frequently at home.
URL: https://www.umin.ac.jp/ctr; Unique identifier: C000000137.
尽管在临床诊室环境中测得的高脉搏率与心血管疾病风险及死亡率增加相关，但评估诊室外脉搏率，尤其是自测的家庭脉搏率的预后能力的研究较少。
我们调查了3022例轻至中度高血压患者家庭脉搏率的预后能力。在中位随访7.3年期间，72例患者死亡，50例发生主要不良心血管事件。治疗前脉搏率每增加1个标准差（9.4次/分钟），全因死亡率的校正风险比为1.52（95%CI，1.24 - 1.92）。随访期间脉搏率每增加1个标准差（9.9次/分钟），校正风险比为1.70（95%CI，1.39 - 2.08）。然而，脉搏率与主要不良心血管事件无显著相关性。当将治疗前家庭脉搏率和诊室脉搏率纳入Cox模型时，仅家庭脉搏率能显著预测全因死亡率（P≤0.019）。将家庭脉搏率从模型中排除会导致模型拟合统计量显著恶化（P≤0.020）。通过受试者工作特征分析的约登指数确定的家庭脉搏率预测全因死亡率的最佳截断值，基线时为67.8次/分钟，随访期间为66.4次/分钟。
在轻至中度高血压患者中，降压治疗前及治疗期间在家测得的脉搏率与死亡风险相关，且与诊室脉搏率相比具有更好的预后能力。使用家庭脉搏率可提高风险分层的准确性，其可在家中轻松且频繁地自行测量。
