Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Telera M P, Pede S, Gattobigio R, Porcellati C
Area Omogenea di Cardiologia e Medicina, Ospedale Regionale Raffaello Silvestrini, Perugia, Italy.
J Hypertens. 1998 Sep;16(9):1335-43. doi: 10.1097/00004872-199816090-00015.
Previous studies revealed a direct association between resting heart rate and risk of mortality in essential hypertension. However, resting heart rate is a highly variable measure since it is affected by the alerting reaction to the visit.
To investigate whether the heart rate values recorded during the 24 h of ambulatory blood pressure monitoring are independent predictors of survival of uncomplicated subjects with essential hypertension.
We followed up 1942 initially untreated and uncomplicated subjects with essential hypertension (mean age 51.7 years, 52% men) for an average of 3.6 years (range 0-10 years). All subjects underwent baseline procedures including 24 h non-invasive blood pressure monitoring with simultaneous assessment of heart rate, one reading every 15 min for 24 h.
All-cause mortality and cardiovascular morbidity.
During follow-up there were 74 deaths from all causes (1.06 per 100 person-years) and 182 total (fatal plus non-fatal) cardiovascular morbid events (2.66 per 100 person-years). Clinic, average 24 h, daytime and night-time heart rates exhibited no association with total mortality. However, the subjects who subsequently died had had a blunted reduction of heart rate on going from day to night during the baseline examination. After adjustment for age (P < 0.001), diabetes (P < 0.001) and average 24 h systolic blood pressure (SBP, P= 0.002) in a Cox model, for each 10% less reduction in the heart rate from day to night the relative risk of mortality was 1.30 (95% confidence interval 1.02-1.65, P = 0.04). Rates of death were 0.38, 0.71, 0.94 and 2.0 per 100 person-years among subjects in the four quartiles of the distribution of the percentage reduction in heart rate from day to night The baseline day-night changes in the heart rate exhibited an inverse correlation to age and to clinic and ambulatory SBP and a direct association with the day-night changes in blood pressure. The degree of reduction of heart rate from day to night also had an independent inverse association with total cardiovascular morbidity after adjustment for age, diabetes and left ventricular hypertrophy, but this association did not remain significant when average 24 h SBP and the degree of day-night reduction in SBP were entered into the equation.
A flattened diurnal rhythm of heart rate in uncomplicated subjects with essential hypertension is a marker of risk for subsequent all-cause mortality and this association persists after adjustment for several risk factors. For assessing these subjects, a limited and uniformly distributed period of ambulatory heart rate recording during the 24 h is clinically valuable.
既往研究揭示了静息心率与原发性高血压患者死亡风险之间存在直接关联。然而，静息心率是一项高度可变的指标，因为它会受到就诊时警觉反应的影响。
探讨动态血压监测24小时期间记录的心率值是否为原发性高血压未合并并发症患者生存情况的独立预测因素。
我们对1942例初始未接受治疗且无并发症的原发性高血压患者（平均年龄51.7岁，52%为男性）进行了平均3.6年（范围0 - 10年）的随访。所有受试者均接受了包括24小时无创血压监测及同步心率评估在内的基线检查，每15分钟记录一次，共24小时。
全因死亡率和心血管疾病发病率。
随访期间共有74例全因死亡（每100人年1.06例）和182例总计（致命加非致命）心血管疾病事件（每100人年2.66例）。诊室、平均24小时、日间和夜间心率与总死亡率均无关联。然而，在基线检查期间，随后死亡的受试者从白天到夜间心率下降幅度较小。在Cox模型中对年龄（P < 0.001）、糖尿病（P < 0.001）和平均24小时收缩压（SBP，P = 0.002）进行校正后，从白天到夜间心率每降低10%，死亡相对风险为1.30（95%置信区间1.02 - 1.65，P = 0.04）。在白天到夜间心率降低百分比分布的四个四分位数区间内，受试者的死亡率分别为每100人年0.38例、0.71例、0.94例和2.0例。基线时白天到夜间的心率变化与年龄、诊室及动态SBP呈负相关，与血压的昼夜变化呈正相关。在对年龄、糖尿病和左心室肥厚进行校正后，白天到夜间心率降低程度与总心血管疾病发病率也呈独立负相关，但当将平均24小时SBP及SBP的昼夜降低程度纳入方程后，这种关联不再显著。
原发性高血压未合并并发症患者心率昼夜节律变平是随后全因死亡风险的一个标志，且在对多个风险因素进行校正后这种关联仍然存在。对于评估这些患者，24小时内有限且均匀分布的动态心率记录时段具有临床价值。
