scholarly journals Resting Heart Rate and Cardiovascular Outcomes during Intensive and Standard Blood Pressure Reduction: An Analysis from SPRINT Trial

2021 ◽  
Vol 10 (15) ◽  
pp. 3264
Author(s):  
Piotr Sobieraj ◽  
Maciej Siński ◽  
Jacek Lewandowski
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Risk Factor ◽  
Systolic Blood Pressure ◽  
Blood Pressure Reduction ◽  
Cardiovascular Death ◽  
Hazard Ratio ◽  
Resting Heart Rate ◽  
Coronary Syndrome ◽  
The Relationship

The association between elevated resting heart rate (RHR) as a cardiovascular risk factor and lowering of systolic blood pressure (SBP) to currently recommended values remain unknown. Systolic Blood Pressure Intervention Trial (SPRINT) data obtained from the NHLBI were used to describe the relationship between RHR and SBP reduction to <120 mmHg compared to SBP reduction to <140 mmHg. The composite clinical endpoint (CE) was defined as myocardial infarction, acute coronary syndrome, decompensation of heart failure, stroke, or cardiovascular death. Increased RHR was associated with a higher CE risk compared with low RHR in both treatment arms. A more potent increase of risk for CE was observed in subjects who were allocated to the SBP < 120 mmHg treatment goal. A similar effect of intensive and standard blood pressure (BP) reduction (p for interaction, 0.826) was observed in subjects with RHR in the 5th quintile (hazard ratio, 0.78, with 95% confidence interval (CI), 0.55–1.11) and in other quintiles of baseline RHR (hazard ratio, 0.75, with 95% CI, 0.62–0.90). Lower in-trial than baseline RHR was associated with reduced CE risk (hazard ratio, 0.80, with 95% CI, 0.66–0.98). We concluded that elevated RHR remains an essential risk factor independent of SBP reduction.

scholarly journals The impact of resting heart rate measured on cardiovascular events in subject with hypertension

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Sobieraj ◽  
J Lewandowski ◽  
M Sinski
Keyword(s):  
Cardiovascular Disease ◽  
Heart Rate ◽  
Risk Factor ◽  
Cardiovascular Events ◽  
Independent Risk Factor ◽  
Hazard Ratio ◽  
Resting Heart Rate ◽  
Coronary Syndrome ◽  
The Impact ◽  
The Relationship

Abstract Background Available evidence does not indicate whether resting heart rate (RHR) is an independent risk factor or just marker of elevated risk. None of the studies assessed impact of RHR on cardiovascular events, when RHR was measured using automated blood pressure measurements (AOBPM). Purpose To assess the relationship between RHR (measured using AOBPM) and cardiovascular events risk in subjects with hypertension. Methods The data of SPRINT trial obtained via NHLBI were used to perform the analysis. SPRINT trial assessed intensive lowering of systolic BP to a target &lt;120 mm Hg in comparison to standard goal (&lt;140 mm Hg). RHR was measured using AOBPM device and calculated as an average of 3 measurements during the baseline visit of the study. Clinical composite endpoint (CE) of the study was defined as: myocardial infarction, acute coronary syndrome, decompensation of heart failure, stroke or cardiovascular death. The relationship between RHR and CE was assessed according to presence of cardiovascular disease (CVD) in past medical history. The statistical methods included t-test and chi-square test, Cox proportional risk models. The Cox models were adjusted for adjusted for age, sex, current smoking status and mean SBP during the trial. Restricted cubic splines were used to describe the relationship between RHR and hazard ratio. Results Data of 1877 participants with CVD and 7484 participants without CVD were analyzed. Subjects with cardiovascular disease were older (69.7±9.5 vs 67.5 years ± 9.4, p&lt;0.001), more often were men (72.8% vs 62.3%, p&lt;0.001) and had prior chronic kidney disease (34.3% vs 26.8%, p&lt;0.001) than subjects without CVD. CE was more than twice often when CVD was present (10.9% vs 4.8%, p&lt;0.001). RHR was lower in subjects with CVD disease than in subjects without CVD (63.6±11 vs 66.9±11.6 bpm, p=0&lt;00.1). Elevated RHR was associated with increased risk both in subjects with and without CVD (Figure 1). The multivariable Cox proportional hazard risk model revealed that RHR&gt;80 bpm is an independent risk factor for CE in subjects without CVD (hazard ratio 1.37, 95% CI 1.01–1.85, p=0.043) while not in subjects with CVD (hazard ratio 0.99, 95% CI 0.57–1.71, p=0.98). Conclusion Elevated RHR (&gt;80 bpm) measured using AOBPM is an independent risk factor for cardiovascular events in subjects with hypertension and without CVD. Figure 1. Heart ratio vs hazard ratio. Funding Acknowledgement Type of funding source: None

scholarly journals COMPARISON STUDY OF IVABRADINE WITH METOPROLOL IN MANAGEMENT OF ACUTE CORONARY SYNDROME

2021 ◽  
Vol 5 (9) ◽  
Author(s):  
Rishman Tandi ◽  
Tanvi Kumar ◽  
Amritpal Singh Kahlon ◽  
Aaftab Sethi
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Coronary Syndrome ◽  
Group A ◽  
Group B

Introduction: Acute coronary syndrome remains as one of the most important causes for morbidity and mortality in developed countries. Therefore, evidence-based management strategy is required to offset the loss of health during an acute coronary syndrome. An effective approach includes both medical and surgical methods. This study was conducted to evaluate the medical method of management. Objective: To study blood pressure and heart rate variability after administration of Ivabradine or metoprolol in cases with acute coronary syndrome. Materials and methods: The study was a Prospective single center observational study conducted in patients attending Cardiology Intensive Care Unit in Nayyar Heart and Superspecialty Hospital, a tertiary care centre located in an urban area. All patients with Acute coronary syndrome admitted to the emergency or cardiac care unit were analysed with ECG as a preliminary diagnostic test and confirmed with troponin markers. They were either given Ivabradine or Metoprolol. Baseline evaluation and follow up was done and necessary data was collected and analysed.   Results: 100 patients were included in the study out of which 50 were given Metoprolol (Group A) and 50 were given Ivabradine (Group B). Themean age of studied cases was found to be 66.54 years in group A and 68.69 years in group B. It was observed that there was a fall in heart rate by 26.8 beats per minute with beta blocker and 24.4 beats per minute with Ivabradine. In case of blood pressure measurement, in patients with beta blocker administration, there was a fall of 25 mm Hg in systolic blood pressure and 17 mm Hg in diastolic blood pressure However, with Ivabradine there was only a fall of 8mm Hg in systolic Blood pressure and 6 mm Hg in diastolic blood pressure. Conclusion: Although Metoprolol is the drug of choice to decrease heart rate and blood pressure in acute coronary syndrome, Ivabradine is being increasingly used in cases where beta blockers are contraindicated as it has similar efficacy in lowering heart rate without compromising contractility of cardiac muscle, thereby maintaining LVEF and blood pressure. Keywords: Acute coronary syndrome, Beta Blockers, Metoprolol, Ivabradine.

Heart Failure Events in a Clinical Trial on Arterial Hypertension: New Insights Into the SPRINT Trial

Hypertension ◽  
2021 ◽  
Vol 78 (5) ◽  
pp. 1241-1247
Author(s):  
Piotr Sobieraj ◽  
Peter M. Nilsson ◽  
Thomas Kahan
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Standard Treatment ◽  
Hazard Ratio ◽  
Intensive Treatment ◽  
Coronary Syndrome ◽  
End Point ◽  
Reduced Risk

SPRINT (Systolic Blood Pressure Intervention Trial) showed that intensive lowering of systolic blood pressure to <120 mm Hg was beneficial, as compared with standard treatment in which systolic blood pressure is lowered to <140 mm Hg. The proposal that the results of SPRINT were mainly driven by the reduction of heart failure events has undermined the main conclusion of the study. Therefore, this study aimed to assess whether the intensive treatment group was also associated with a reduced risk of cardiovascular events when heart failure events were excluded from the primary composite end point. The SPRINT data were analyzed with a redefined composite end point including myocardial infarction, acute coronary syndrome other than myocardial infarction, stroke, and cardiovascular death (excluding heart failure events). The results show that intensive treatment (<120 mm Hg) is associated with a reduced risk for the redefined composite end point (hazard ratio, 0.79 [95% CI, 0.66–0.95]; P =0.012), as compared with the standard treatment (<140 mm Hg), and with results similar to the original SPRINT findings (hazard ratio, 0.75 [95% CI, 0.64–0.89]; P <0.001). Overall, the main results of SPRINT are not driven by a reduction in heart failure events. Moreover, this post hoc analysis supports the use of a more intensive treatment strategy for high-risk hypertensive patients. Graphic Abstract: An online graphic abstract is available for this article.

Abstract P021: Association Of Resting Heart Rate With All-cause And Cardiovascular Mortality: Sprint

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Steven J Mould ◽  
Elsayed Z Soliman ◽  
Yashashwi Pokharel ◽  
Elijah Beaty ◽  
Prashant Bhave ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Cardiovascular Mortality ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Channel Blockers ◽  
Resting Heart Rate ◽  
Autonomic Tone

Introduction: Elevated resting heart rate (RHR) has been shown to be associated with both all-cause and cardiovascular mortality. Prior studies have provided conflicting estimates of the strength of each association. To explore the relationship between RHR and competing mortality risks, we sought to compare the association between RHR and cardiovascular and non-cardiovascular mortality among participants in the Systolic Blood Pressure Intervention Trial (SPRINT). Methods: Eligible SPRINT participants had baseline RHR, longitudinal follow-up, and were not using beta blockers or non-dihydropyridine calcium channel blockers. Mortality was classified by a treatment-blinded adjudication committee as cardiovascular if secondary to coronary heart disease, stroke, sudden cardiac death, or congestive heart failure. Multivariable Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CI) for cardiovascular and non-cardiovascular mortality, separately, associated with a 10 beats per minute increase in RHR. Results: Among 5,571 eligible SPRINT participants (67.1 ± 9.4 years, 33.8% female, 63.8% white, mean RHR 70.4±11.8 beats per minute) over a median 3.8 years of follow-up, there were 56 cardiovascular deaths and 176 non-cardiovascular deaths. In models adjusted for age, sex, race, prior cardiovascular disease, smoking, systolic blood pressure, creatinine, total cholesterol, high-density lipoprotein cholesterol, and trial treatment assignment, higher RHR (per ten beat-per-minute increase) was associated with both cardiovascular (HR 1.17, 95% CI 1.02-1.35) and non-cardiovascular mortality (HR 1.27, 95% CI 1.13-1.43). Conclusions: Elevated RHR was associated with both cardiovascular and non-cardiovascular mortality, suggesting that RHR may serve as a marker of both global health rather and cardiovascular health. Higher RHR may reflect imbalance in autonomic tone and further studies are needed to explore the mechanisms of these associations.4

scholarly journals Interaction of systolic blood pressure and resting heart rate with clinical outcomes in takotsubo syndrome: insights from the International Takotsubo Registry

2018 ◽  
Vol 20 (6) ◽  
pp. 1021-1030 ◽  
Author(s):  
Michael Böhm ◽  
Victoria L. Cammann ◽  
Jelena R. Ghadri ◽  
Christian Ukena ◽  
Sebastiano Gili ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Clinical Outcomes ◽  
Takotsubo Syndrome ◽  
Resting Heart Rate

scholarly journals Factors of cardiovascular risk and intervisit arterial pressure variability

2019 ◽  
Vol 1 (7) ◽  
pp. 17-24 ◽  
Author(s):  
T.I. Nimtsovych ◽  
O.Y. Mischeniuk ◽  
A.M. Kravchenko
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Arterial Pressure ◽  
Cardiovascular Death ◽  
Cardiovascular Complications ◽  
Arterial Pressure Variability ◽  
Working Age ◽  
The Relationship

The aim: To determine the relationship between modified, unmodified cardiovascular risk factors (CRF) and intervisit arterial pressure variability (IAPW) in men of working age with arterial hypertension (AH).Material and methods. We examined 160 men with uncomplicated AH, among them, 82 patients had high IAPW, and 78 patients – low IAPW. The average age in patients with high and low IAPW did not differ and was 50.65 ± 6.14 and 50.26 ± 6.27 years, respectively (p = 0.689). Indices of IAPW were calculated based on the standard deviation (SD) of measurements of office blood pressure during 4 visits to the clinic. The criterion for high IAPW was the value of systolic arterial pressor (AP) – 15 / 15 mm Hg (day / night), for diastolic AP – 14/12 mm Hg (day / night). The analysis was carried out using standard statistical methods for parametric and non-parametric parameters. Results. It has been established, that the frequency of both modified and unmodified risk factors is greater in patients with hypertension and high IAPW, than in patients with low IAPW. The presence of obesity (36 of 82 versus 7 of 78; р ≤ 0.0001), family anamnesis (71 of 82 versus 52 of 78; p = 0.004), smoking episodes (62 of 82 versus 12 of 78; р ≤ 0.0001) and alcohol use (24 of 82 versus 2 of 78; p ≤ 0.0001) is significantly more common in patients with high IAPW, than in patients with low level of IAPW. There was a direct correlation between the MBA value and the percentage of 10-year risk of cardiovascular death on the SCORE scale (r = 0.47; p ≤ 0.0001) іn patients with hypertension.Conclusion. The results of the study confirm the hypothesis that, it is expedient to determine IAPW in patients with AH, as an independent prognostic risk factor for cardiovascular complications.  

Fasting Insulin Concentration Is Related to Cardiovascular Reactivity to Exercise in Children

PEDIATRICS ◽  
1995 ◽  
Vol 96 (6) ◽  
pp. 1123-1125
Author(s):  
Bernard Gutin ◽  
Syed Islam ◽  
Frank Treiber ◽  
Clayton Smith ◽  
Tina Manos
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Cardiovascular Reactivity ◽  
Nervous Activity ◽  
Insulin Concentration ◽  
Fasting Insulin ◽  
Prophylactic Measure ◽  
Sympathetic Nervous ◽  
The Relationship

Objective. One mechanism through which hyperinsulinemia is linked to hypertension is through its stimulation of sympathetic nervous activity. Thus, insulin concentration may be correlated with indices of sympathetic activity before it is associated with resting blood pressure. We tested this hypothesis by determining the relationship of insulin concentration and sympathetically mediated cardiovascular reactivity to exercise in children. Design. Survey. Setting. General community. Participants. Volunteer sample of 46 black and white boys and girls, 9 to 11 years of age. Interventions. None. Fasting insulin concentration was the main independent variable. Main outcome measures. Systolic blood pressure and heart rate during a standard submaximal bout of treadmill exercise, and systolic blood pressure at peak effort. Results. The hypothesis was tested by multiple regression analyses controlled for resting values. Insulin contributed significantly to the regression models for submaximal heart rate (P &lt; .001), submaximal systolic blood pressure (P = .001), and peak systolic blood pressure (P = .006). Conclusions. Fasting insulin concentration is associated with cardiovascular reactivity to exercise in young children. This supports the hypothesis that the relationship between hyperinsulinemia and hypertension is mediated by sympathetic nervous tone and that the process begins in childhood. Because percent body fat was positively associated with both insulin and cardiovascular reactivity to exercise, prevention of childhood obesity may be a valuable prophylactic measure for these health problems.

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