AUTHOR=Sun Ningling , Chen Yuanyuan , Xi Yang , Wang Hongyi , Wang Luyan 

TITLE=Association Between Heart Rate and Major Adverse Cardiovascular Events Among 9,991 Hypertentive Patients: A Multicenter Retrospective Follow-Up Study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.741784

DOI=10.3389/fcvm.2021.741784

ISSN=2297-055X

ABSTRACT=<p><bold>Objective:</bold> To assess the effect of heart rate at baseline on major adverse cardiovascular events (MACEs) among hypertensive patients in China.</p><p><bold>Methods:</bold> A multicenter retrospective study was conducted with a 24 month follow-up period. A total of 10,031 hypertensive patients treated with standard antihypertensive drugs were grouped according to their heart rate before treatment: &lt;65 beats per min (bpm), 65–69 bpm, 70–74 bpm, 75–79 bpm, and ≥80 bpm. The occurrence of any of MACEs was as the endpoint event during the 24 month follow-up period. The effect of heart rate at baseline on MACEs was analyzed using univate and multivariable Cox proportional regression analyses, with hazard ratios (HRs) and 95% confidence intervals (CIs). The restricted cubic spline (RCS) model was used to fit the Cox proportional harzard model with 5 knots at the 5<sup>th</sup>, 25<sup>th</sup>, 50<sup>th</sup>, 75<sup>th</sup>, and 95<sup>th</sup> percentiles of heart rate.</p><p><bold>Results:</bold> Totally 9,991 patients were finally enrolled with the mean systolic pressure (SBP)/diastolic pressure (DBP) of 130.59 ± 7.13/77.66 ± 5.99 mmHg at 24 month follow-up. The incidence of MACEs was 4.80% (<italic>n</italic> = 480). After adjustment for age, gender, baseline blood pressure, alcohol drinking, smoking, hyperlipidemia, diabetes, coronary heart disease, cerebrovascular disease and antihypertensive drug use, patients with heart rate &lt;65 bpm (HR = 1.450, 95% CI: 1.098–1.915) and ≥80 bpm (HR = 1.391, 95% CI: 1.056–11.832) showed 0.45 fold and 0.391 fold increases of MACE risks, compared with patients with heart rate of 70–74 bpm. Furthermore, MACE risks were increased by 86.0% and 65.4% in men, and 59.3% and 69.0% in elderly patients aged ≥65 years at heart rate &lt;65 bpm or ≥80 bpm, respectively. We also found a non-liner U-shaped correlation between heart rate and the occurrence of MACEs.</p><p><bold>Conclusions:</bold> Heart rate might be an independent risk factor for MACEs in hypertensive patients. An appropriate range of heart rate control may offer guidance to hypertension treatment.</p>