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Resting heart rate and risk of hypertension: results of the Kailuan cohort study

Wang, Anxina,b,*; Liu, Xiaoxuec,d,*; Guo, Xiuhuaa,b; Dong, Yanc; Wu, Yuntaoe; Huang, Zhee; Xing, Aijune; Luo, Yanxiaa,b; Jonas, Jost B.f,*; Wu, Shoulinge,*

doi: 10.1097/HJH.0000000000000230

Objective: Resting heart rate (RHR) is a predictive risk factor of the development of cardiovascular diseases, but its association with arterial hypertension has remained unclear. This study investigated the relationship between RHR and new-onset hypertension (NOH) in an Asian population.

Methods: The Kailuan study is a prospective longitudinal cohort study on cardiovascular risk factors and cardiovascular or cerebrovascular events. Hazard ratios with 95% confidence intervals (CIs) were calculated using Cox regression modelling.

Results: Out of 101 510 individuals originally included into the Kailuan study, 31 507 participants (mean age: 46.3 ± 11.5 years) were selected with no previous arterial hypertension or cardiac arrhythmias. After a mean follow-up period of 3.5 ± 0.9 years, 12 565 (39.88%) individuals developed arterial hypertension. Incidence of hypertension was 104.4, 109.7, 114.2 and 124.6 per 1000 person-years for each RHR quartile. In multivariate analysis with adjustment for blood pressure, blood lipids, diabetes mellitus and other parameters, hazard ratios for NOH increased significantly (P < 0.0001) with increasing RHR quartile. Increase in RHR by 10 beats/minute was associated with an 8% increase in NOH. Individuals in the highest RHR quartile as compared with participants in the lowest quartile demonstrated a 16% greater risk of developing NOH [hazard ratio 1.16; 95% confidence interval (CI) 1.11–1.23]. There were no significant interactions between RHR and prehypertension, diabetes mellitus, age and BMI in terms of NOH risk, respectively.

Conclusion: Independently of other baseline parameters such as blood pressure, blood lipids and diabetes mellitus, elevated RHR significantly increases the risk of incident hypertension. Measuring RHR is helpful in predicting the risk of eventual arterial hypertension.

aDepartment of Epidemiology and Health Statistics, School of Public Health

bBeijing Municipal Key Laboratory of Clinical Epidemiology, Beijing

cHebei United University

dDepartment of Cardiology, Tangshan People's Hospital

eDepartment of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China

fDepartment of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany

*Anxin Wang and Xiaoxue Liu contributed to this work and share the first authorship. Jost B. Jonas and Shouling Wu share the last authorship.

Correspondence to Yanxia Luo, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, 100069, China. Tel: +86 10 83911779; fax: +86 10 83911777; e-mail:

Abbreviations: bpm, beats per minute; CI, confidence intervals; DALYs, disability-adjusted life years; HDL, high-density lipoproteins; HR, hazard ratios; LDL, low-density lipoproteins; NOH, new-onset hypertension; RHR, Resting heart rate; YLDs, years lived with disability

Received 11 November, 2013

Revised 28 March, 2014

Accepted 28 March, 2014

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