Ambulatory heart rate and target organ damage in never-treated essential hypertensives

Abstract

Limited evidence is available about the relationship between ambulatory heart rate (HR) and target organ damage (TOD) in uncomplicated hypertension. We sought to investigate the association between ambulatory HR and subclinical cardiac, vascular and renal markers of TOD in never-treated essential hypertensives. A total of 580 subjects with recently diagnosed (p1 year) grade 1 and 2 hypertension, categorized by tertiles of HR levels, assessed by two 24-h ambulatory blood pressure monitoring at 1-to 4-week interval, sex and the presence or absence of TOD were considered for this analysis. All subjects also underwent laboratory and ultrasonographic investigations searching for microalbuminuria (MA), left ventricular hypertrophy (LVH) and carotid atherosclerosis (carotid thickening/plaque). In the whole population, as well as in both genders, LVH, carotid atherosclerosis and MA prevalence rates did not significantly increase with 48-h HR tertiles. When patients were categorized according to the presence or absence of TOD (that is, LVH, carotid atherosclerosis or MA) no significant intergroup differences in 48-h HR were found. Furthermore, average 48-h HR was similar in patients without organ involvement as in those with one, two or three TOD signs. Finally, in a multivariate analysis age, 48-h systolic blood pressure and metabolic syndrome assessed by ATP III criteria, but not HR were independently associated with TOD. Our findings showing that 48-h ambulatory HR is not associated with markers of TOD do not support the view that a faster HR may have an additive value in predicting organ damage in the early phases of essential hypertension.

Pulse pressure and nocturnal fall in blood pressure are predictors of vascular, cardiac and renal target organ damage in hypertensive patients (LOD-RISK study)

“…There is even more controversy about the relationship between heart rate and target organ damage. In a recent study, Cuspidi et al did not find conclusive data to support this relationship [22,25]. In our study we found that the lower heart rate is associated, in patients without pharmacological treatment, with higher target organ damage, except for renal damage, assessed by the albumin/creatinine ratio, which seems to be directly related to increased heart rate, and therefore the relationship between heart rate and target organ involvement is not clear.…”

Office and 24-hour heart rate and target organ damage in hypertensive patients

“…Probably the higher prevalence of TOD found in this study, as well as the analysis of HR with different types of measurements, together with a higher percentage of males and patients without treatment influenced the differences found between the two studies. However, Cuspidi et al [16] found that 48-h ambulatory HR was not associated with markers of target organ damage in the early phases of essential hypertension.…”

“…In addition, proteinuria values may be increased in subjects with an elevated HR, even in normotensive individuals [15]. The association of HR (both sleep and awake HR) and its variability with vascular, renal and cardiac target organ damage (TOD) in a cohort of hypertensive patients has not been clearly established [16,17]. …”

Non-Dipping Heart Rate and Microalbuminuria in Type 2 Diabetes Mellitus

“…Only one other study has assessed the relation between microalbuminuria and HR using ABPM, but this was not done in a diabetic population. Cuspidi et al [13] found that in 580 consecutive never-treated essential hypertensive patients, 48-hour ambulatory HR was not associated with markers of TOD, including microalbuminuria.…”

“…Besides being an indicator of incipient renal injury (especially in diabetic and hypertensive patients) [10], microalbuminuria is also a marker of atherosclerosis and generalised endothelial dysfunction. The few studies conducted to assess the relation between HR and microalbuminuria were mainly performed in essential hypertensive patients [11,12,13,14], with only one study investigating this association in diabetic patients [15]. The latter study was a post hoc analysis, with the known limitations associated with such an approach.…”