The relative role of office heart rate (HR) and ambulatory HR for predicting major adverse cardiovascular events (MACEs) and mortality is not well known. Aim of this study was to investigate the association of white-coat tachycardia and masked tachycardia with MACE and mortality in hypertensive patients.
We performed 24-h ambulatory blood pressure and HR monitoring in 7602 hypertensive patients (4165 men) aged 52 ± 16 years enrolled in six prospective studies in Italy, Japan, and Australia. Participants were divided into four groups: normal office and normal night-time HRs (N = 5238), white-coat tachycardia (N = 998), masked tachycardia (N = 796), and sustained tachycardia (N = 570). Median follow-up was 5.0 years.
In age-and-sex-adjusted Cox model, using the normal HRs group as a reference, white-coat tachycardia was not a significant predictor of excess MACEs or all-cause death. In contrast, both masked tachycardia [hazard ratio, 95% confidence interval (CI); 1.40, 1.11–1.77] and sustained tachycardia (1.86, 1.44–2.40) were associated with risk of excess MACE. In addition, masked tachycardia (hazard ratio, 95% CI; 1.62, 1.14–2.29) but not sustained tachycardia (1.35, 0.83–2.19) was a significant predictor of excess mortality. These relationships held true in multivariable parsimonious Cox models including major risk factors. In these models, masked tachycardia remained an independent predictor of excess MACE (hazard ratio, 95% CI; 1.34, 1.06–1.71) and all-cause mortality (1.68, 1.18–2.41).
The current study confirms that measurement of HR adds to the risk stratification for MACE and mortality and shows that an elevated night-time HR confers an increased mortality risk to hypertensive patients who have normal office HR.
aUniversity of Padova, Padua
bUniversity of Perugia, Perugia, Italy
cUniversity of Western Australia, Perth, Western Australia, Australia
dJichi University, Shimotsuke, Tochigi
eTohoku University, Sendai
fTeikyo University School of Medicine, Tokyo, Japan
gUniversity of Chieti, Chieti, Italy
iStony Brook University, New York, New York, USA
jFlinders University, Adelaide, South Australia, Australia
kHospital of Assisi, Assisi, Italy
Correspondence to Prof Paolo Palatini, MD, Department of Medicine, University of Padova, Via Giustiniani, 2 35128 Padova, Italy. Tel: +39 049 8212278; fax: +39 049 8754179; e-mail: firstname.lastname@example.org
Abbreviations: ABP-International, Ambulatory Blood Pressure in Referred Hypertensive Subjects-- an International Database; BP, blood pressure; HR, heart rate; MACE, major adverse cardiovascular event
Received 9 September, 2016
Revised 13 October, 2016
Accepted 28 October, 2016