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Effect modification of aortic atheroma on the prognostic value of heart rate in hypertension

Courand, Pierre-Yvesa,b,c; Milon, Huguesa,b,c; Gustin, Marie-Pauleb,c; Froment, Alain*; Bricca, Giampierob,c; Lantelme, Pierrea,b,c,d

doi: 10.1097/HJH.0b013e32835c44bb
ORIGINAL PAPERS: Epidemiology

Background: Although some epidemiological studies have advocated a prognostic value of heart rate (HR) in hypertensive patients, the influence of vascular damages on this prognostic value has not been tested yet.

Methods: HRs were collected by pulse palpation in 1204 primary hypertensive patients in sinus rhythm without cardiac-slowing drugs. Aortic damages were assessed by aortography, whereas cardiac disease was assessed by medical history, symptoms and electrocardiogram.

Results: In a multivariable Cox model adjusted for major confounders, HR was of prognostic significance for all-cause [hazard ratio 1.12 (1.06–1.19) for 10 bpm increment and 1.39 (1.18–1.64) for HR ≥82 vs. <82 bpm] and cardiovascular death [hazard ratio 1.10 (1.02–1.20) for 10 bpm increment and 1.37 (1.09–1.72) for HR ≥82 vs. <82 bpm] after 35 years of follow-up. This association was particularly manifested at 15 years of follow-up. At that time, with the same multivariable survival model, the association between HR and cardiovascular death was stronger in patients with aortic atheroma [2.76 (1.47–5.18) for an HR ≥82 vs. <82 bpm] than in patients without [hazard ratio 1.36 (0.76–2.43) for an HR ≥82 vs. <82 bpm, P for interaction = 0.054]. Similarly, the association between HR and cardiovascular death was stronger in patients with an overt cardiac disease than those without (P for interaction = 0.044).

Conclusion: In hypertensive patients, the prognostic significance of HR for cardiovascular outcome is modulated by the presence of aortic atherosclerosis or cardiac disease. This should prompt us to a thorough examination of cardiovascular damages in hypertensive patients when HR is elevated.

aDepartment of Cardiology, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon

bUniversité Lyon-1, Villeurbanne

cGénomique Fonctionnelle de l’Hypertension Artérielle

dDepartment of Cardiology, Hôpital Nord Ouest, Villefranche-sur-Saône, France

*Deceased.

Correspondence to Pierre Lantelme, Department of Cardiology, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, F-69004, Lyon, France. Tel: +33 472 071 667; fax: +33 472 071 674; e-mail: pierrelantelme@hotmail.com

Abbreviations: BP, blood pressure; BPM, beats per minute; CI, confidence interval; CT, computed tomography; HR, heart rate; LVH, left ventricular hypertrophy; PP, pulse pressure

Received 12 June, 2012

Revised 16 September, 2012

Accepted 5 November, 2012

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© 2013 Lippincott Williams & Wilkins, Inc.