Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease: findings from the INternational VErapamil-SR/trandolapril STudy (INVEST)

Abstract

Among CAD patients with hypertension, RHR predicts adverse outcomes, and on-treatment RHR is more predictive than baseline RHR. A Ve strategy is less effective than an At strategy for lowering RHR but has a similar effect on adverse outcomes.

Resting Heart Rate Pattern During Follow-Up and Mortality in Hypertensive Patients

“…We found that HR was an independent predictor of all-cause, CV, and IHD mortality in these patients. Although this is in keeping with results from other studies, [7][8][9][10][11] we showed that the change in HR achieved during follow-up of hypertensive patients was a better predictor of risk than baseline or final HR. We also showed that, after correction for rate-limiting therapy (␤-blockers and nondihydropyridine calcium channel blockers), HR remained a significant independent risk factor.…”

“…As in INVEST, 11 there appeared to be a continuous relationship between baseline HR and adverse outcomes with only weak evidence of a noncontinuous relationship for CV mortality. Again, in keeping with INVEST, on-treatment HR was more predictive than baseline HR.…”

“…5 The International Verapamil-SR/Trandolapril Study (INVEST) found follow-up HR to show a J-shaped relationship with adverse outcome in patients with coronary artery disease and hypertension. 11 An analysis of the placebo-treated arm of the Systolic Hypertension in Europe Trial identified an association between HR and mortality in elderly patients, although follow-up was relatively short and the predictive power of HR lost significance after adjustment in the treated arm. 12 A large metaanalysis 13 suggested that reduction in HR (because of ␤-blockers) did not confer any additional benefit in hypertensive patients.…”

New practice guidelines for perioperative beta blockade from the United States and Europe: incremental progress or a necessary evil?

“…35 The medical literature on which these recommendations rest is based in large part on the long-term outcome of patients with known CAD or hypertension, suggesting better survival with heart rates in the 60-70 beatsÁmin -1 range but also reporting evidence of adverse survival with lower ranges. [36][37][38][39] These controversies emphasize the problems of applying findings from a patient group in one context, i.e., long-term survival in medical patients, to the more dynamic and shorter term perioperative setting. The association of heart rate control with beta blockade with perioperative outcome remains controversial.…”

“…Toutefois, cette littérature rapporte également une survie diminuée lorsque la fenêtre a des valeurs plus basses. [36][37][38][39] Toutes ces controverses mettent en exergue les problèmes qui émergent lorsqu'on tente d'appliquer les résultats d'un groupe de patients dans un contexte donné, soit la survie à long terme de patients médicaux, au contexte périopératoire, lequel est à la fois plus dynamique et à plus court terme.…”