Prognostic significance of home heart rate in the Japanese HOMED-BP study

Objective: Evidence about the prognostic significance of home pulse rate has been lacking and inconsistent. In this study, we examined the relationship between pulse rate and prognosis using follow-up data from the Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP) study.

Methods: The HOMED-BP study was a clinical trial with a 2×3 factorial design, blood pressure control (tight vs. usual), and the drug classes for starting treatment (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or calcium channel blockers). The current analysis included 3022 subjects (women: 50.2%, mean age 59.4 ± 9.9 years) for whom home pulse data were available. The home pulse rate in the morning during the untreated observation period immediately before randomization and in the on-treatment follow-up period were analyzed for all-cause mortality and major adverse cardiovascular events (MACE). A Cox proportional hazards model was adjusted for the baseline characteristics of sex, age, body mass index, current smoking, drinking, diabetes mellitus, hypercholesterolemia, history of cardiovascular disease, and randomization group.

Results: The home pulse rate in the morning during the observation period was 69.0 ±9.4 bpm during the untreated observation period and 67.1±9.9 at home, and 74.0 bpm during the on-treatment follow-up period. Home systolic/diastolic blood pressures in the morning were 151.8±12.5 / 90.1±10.0 mmHg during the untreated observation period and 129.7±13.1 / 76.6±9.5 mmHg in the on-treatment follow-up period.

During the 7-year follow-up period, 872 patients died, and 50 developed major adverse cardiovascular events (MACE). Patients with a home pulse rate in the morning during the untreated observation period higher than 76 bpm (top quintile) had a 3.0 times greater risk of mortality than patients with a pulse rate lower than 61 bpm. The hazard ratio for mortality per 1 standard deviation increase in pulse rate was 1.56 (95% confidence interval 1.25-1.95). As sensibility analysis, we further adjusted for 1) eGFR and total hemoglobin level, 2) use of beta-blocker, and found similar hazard ratios, 1.62 (1.28-2.05) and 1.51 (1.18-1.93), respectively. Similar findings were observed for the home pulse rate in the morning in the on-treatment follow-up period. On the other hand, we found no significant results for MACE.

Conclusion: In patients with mild-to-moderate hypertension, the pulse rate obtained by home blood pressure measurement should be considered a predictor of all-cause mortality risk.

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