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Effect of Dietary Fiber (Oat bran) Supplement in Heart Rate Lowering in Patients with Hypertension: A Randomized DASH-Diet-Controlled Clinical Trial. Nutrients 2022; 14:nu14153148. [PMID: 35956324 PMCID: PMC9370281 DOI: 10.3390/nu14153148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: The management goal for patients with essential hypertension (HTN) is not only to lower blood pressure (BP), but also to control increased heart rate (HR). In a previous study, it was found that dietary fiber (DF) supplementation can effectively reduce BP in patients with HTN. The aim of this study was to determine whether a DF supplement can lower HR in patients with HTN. (2) Methods: Seventy patients who met the inclusion and exclusion criteria were randomly allocated into the control group (n = 34) and the intervention group (n = 36). The regular DASH dietary care was delivered to both groups of patients. In addition, one bag of oat bran (30 g/d, containing DF 8.9 g) was delivered to the intervention group. The 24 h ambulatory heart rate was measured at baseline and 3 months. (3) Results: At 3 months, the 24 h maximum heart rate (24h maxHR) in the intervention group was significantly lower than that in the control group. After the intervention, within-group comparisons in the intervention group revealed that there were significant reductions in the 24 h average heart rate (24h aveHR), 24h maxHR, average heart rate during day time (D-aveHR), minimum heart rate during day time (D-minHR), and maximum heart rate during day time (D-maxHR). Similar differences were not found in the control group. (4) Conclusions: Dietary fiber (oat bran) supplementation might be beneficial in lowering HR in patients with HTN.
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2
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Chinali M, Aurigemma GP, Gerdts E, Wachtell K, Okin PM, Muthiah A, Kjeldsen SE, Julius S, de Simone G, Devereux RB. Development of systolic dysfunction unrelated to myocardial infarction in treated hypertensive patients with left ventricular hypertrophy. The LIFE Study. EXPLORATION OF MEDICINE 2022. [DOI: 10.37349/emed.2022.00082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: While it is commonly thought that left ventricular (LV) systolic function may insidiously deteriorate in hypertensive patients, few prospective data are available to support this notion.
Methods: We evaluated 680 hypertensive patients (66 ± 7 years; 45% women) with electrocardiographic (ECG)-LV hypertrophy (ECG-LVH) enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echo-sub-study free of prevalent cardiovascular disease and with baseline ejection fraction (EF) ≥ 55%. Echocardiographic examinations were performed annually for 5 years during anti-hypertensive treatment. Development of reduced systolic function was defined as incident EF < 50%.
Results: During a mean follow-up of 4.8 ± 1 years, 37 patients developed reduced EF without an inter-current myocardial infarction (5.4%). In analysis of covariance, patients who developed reduced EF were more often men, had greater baseline LV diameter and LV mass, lower mean EF (all P < 0.05), and similar diastolic function indices. At the last available examination before EF reduction, independently of covariates, patients with reduced EF showed a significant increase in left atrium (LA) size, LV diameter, end-systolic stress and mitral E/A ratio, as compared to those who did not develop reduced EF (all P < 0.05). In time-varying Cox regression analysis, also controlling for baseline EF, predictors of developing reduced EF were higher in-treatment LV diameter [hazard ratio (HR) = 5.19 per cm; 95% confidence interval (CI): 2.58–10.41] and higher in-treatment mitral E/A ratio (HR = 2.37 per unit; 95% CI: 1.58–3.56; both P < 0.0001).
Conclusions: In treated hypertensive patients with ECG-LVH at baseline, incident reduced EF is associated with the development of dilated LV chamber and signs of increased LV filling pressure (ClinicalTrials.gov identifier: NCT00338260).
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Affiliation(s)
- Marcello Chinali
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA; Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; Division of Cardiology, Bambino Gesù Children’s Hospital–IRCSS, 001655 Rome, Italy; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 02241, USA
| | - Gerard P. Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 02241, USA
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
| | - Kristian Wachtell
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Peter M. Okin
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Anujan Muthiah
- Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway
| | - Sverre E. Kjeldsen
- Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Giovanni de Simone
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA; Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Richard B. Devereux
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
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3
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Aksenova AV, Sivakova OA, Blinova NV, Danilov NM, Elfimova EM, Kisliak OA, Litvin AY, Oshchepkova EV, Fomin VV, Chikhladze NM, Shelkova GV, Chazova IE. Russian Medical Society for Arterial Hypertension expert consensus. Resistant hypertension: detection and management. TERAPEVT ARKH 2021; 93:1018-1029. [DOI: 10.26442/00403660.2021.09.201007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 01/04/2023]
Abstract
The diagnosis of resistant arterial hypertension allows us to single out a separate group of patients in whom it is necessary to use special diagnostic methods and approaches to treatment. Elimination of reversible factors leading to the development of resistant arterial hypertension, such as non-adherence to therapy, inappropriate therapy, secondary forms of arterial hypertension, leads to an improvement in the patient's prognosis. Most patients with resistant hypertension should be evaluated to rule out primary aldosteronism, renal artery stenosis, chronic kidney disease, and obstructive sleep apnea. The algorithm for examining patients, recommendations for lifestyle changes and a step-by-step therapy plan can improve blood pressure control. It is optative to use the most simplified treatment regimen and long-acting combined drugs. For a separate category of patients, it is advisable to perform radiofrequency denervation of the renal arteries.
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Safford MM, Reshetnyak E, Sterling MR, Richman JS, Muntner PM, Durant RW, Booth J, Pinheiro LC. Number of Social Determinants of Health and Fatal and Nonfatal Incident Coronary Heart Disease in the REGARDS Study. Circulation 2020; 143:244-253. [PMID: 33269599 PMCID: PMC7856168 DOI: 10.1161/circulationaha.120.048026] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Social determinants of health (SDH) are individually associated with incident coronary heart disease (CHD) events. Indices reflecting social deprivation have been developed for population management, but are difficult to operationalize during clinical care. We examined whether a simple count of SDH is associated with fatal incident CHD and nonfatal myocardial infarction (MI). METHODS We used data from the prospective longitudinal REGARDS cohort study (Reasons for Geographic and Racial Differences in Stroke), a national population-based sample of community-dwelling Black and White adults age ≥45 years recruited from 2003 to 2007. Seven SDH from the 5 Healthy People 2020 domains included social context (Black race, social isolation); education (educational attainment); economic stability (annual household income); neighborhood (living in a zip code with high poverty); and health care (lacking health insurance, living in 1 of the 9 US states with the least public health infrastructure). Outcomes were expert adjudicated fatal incident CHD and nonfatal MI. RESULTS Of 22 152 participants free of CHD at baseline, 58.8% were women and 42.0% were Black; 20.6% had no SDH, 30.6% had 1, 23.0% had 2, and 25.8% had ≥3. There were 463 fatal incident CHD events and 932 nonfatal MIs over a median of 10.7 years (interquartile range, 6.6 to 12.7). Fewer SDHs were associated with nonfatal MI than with fatal incident CHD. The age-adjusted incidence per 1000 person-years increased with the number of SDH for both fatal incident CHD (0 SDH, 1.30; 1 SDH, 1.44; 2 SDH, 2.05; ≥3 SDH, 2.86) and nonfatal MI (0 SDH, 3.91; 1 SDH, 4.33; ≥2 SDH, 5.44). Compared with those without SDH, crude and fully adjusted hazard ratios for fatal incident CHD among those with ≥3 SDH were 3.00 (95% CI, 2.17 to 4.15) and 1.67 (95% CI, 1.18 to 2.37), respectively; hazard ratios for nonfatal MI among those with ≥2 SDH were 1.57 (95% CI, 1.30 to 1.90) and 1.14 (95% CI, 0.93 to 1.41), respectively. CONCLUSIONS A greater burden of SDH was associated with a graded increase in risk of incident CHD, with greater magnitude and independent associations for fatal incident CHD. Counting the number of SDHs may be a promising approach that could be incorporated into clinical care to identify individuals at high risk of CHD.
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Affiliation(s)
- Monika M Safford
- Department of Medicine, Weill Cornell Medicine, New York (M.M.S., E.R., M.R.S., L.C.P.)
| | - Evgeniya Reshetnyak
- Department of Medicine, Weill Cornell Medicine, New York (M.M.S., E.R., M.R.S., L.C.P.)
| | - Madeline R Sterling
- Department of Medicine, Weill Cornell Medicine, New York (M.M.S., E.R., M.R.S., L.C.P.)
| | - Joshua S Richman
- Department of Surgery (J.S.R.), University of Alabama at Birmingham Medical School
| | - Paul M Muntner
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health (P.M.M., J.B.)
| | - Raegan W Durant
- Department of Medicine (R.W.D.), University of Alabama at Birmingham Medical School
| | - John Booth
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health (P.M.M., J.B.)
| | - Laura C Pinheiro
- Department of Medicine, Weill Cornell Medicine, New York (M.M.S., E.R., M.R.S., L.C.P.)
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5
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Zhao M, Chen Y, Wang M, Wang C, Yao S, Li Y, Zhang S, Yun C, Wu S, Xue H. Relationship between resting heart rate and incident heart failure in patients with hypertension: The Kailuan Cohort Study in China. J Clin Hypertens (Greenwich) 2020; 22:2325-2331. [PMID: 33017515 DOI: 10.1111/jch.14062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022]
Abstract
An elevated heart rate increases the risk of cardiovascular disease, but the relationship between resting heart rate (RHR) and the risk of heart failure (HF) in hypertensive patients is unclear. This study was performed to assess the relationship between elevated RHR and incident HF in hypertensive patients. In total, 16 286 hypertensive patients from the Kailuan cohort were enrolled and underwent three physical examinations. According to mean RHR based on quartile, the hypertensive patients were divided into four groups: Q1 (mean RHR ≤ 69 bpm), Q2 (69 bpm < mean RHR ≤ 74 bpm), Q3 (74 bpm < mean RHR ≤ 79 bpm), and Q4 (mean RHR > 79 bpm). The cumulative mortality rate was analyzed by using the Kaplan-Meier method, with comparisons among RHR quartiles. Cox proportional hazards regression models and restricted cubic spline models were established to evaluate the association between RHR and risk of incident HF. After adjustment for confounders, the hazard ratio (HR) for HF was 1.97(95% CI: 1.28-3.04, P < .001) in the fourth quartile compared to the first quartile. Each 1-standard deviation [10 (beats/min)] increase in RHR was associated with a 40% increase in the risk of incident HF. Restricted cubic spline models presented a linear relationship between RHR and incident HF. Our study suggests that elevated RHR is associated with an enhanced risk of HF in hypertensive patients.
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Affiliation(s)
- MaoXiang Zhao
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yanming Chen
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Miao Wang
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chi Wang
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Siyu Yao
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yao Li
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Sijin Zhang
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Cuijuan Yun
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, Tangshan, China
| | - Hao Xue
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
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Şahinarslan A, Gazi E, Aktoz M, Özkan Ç, Okyay GU, Elalmış ÖU, Belen E, Bitigen A, Derici Ü, Tütüncü NB, Yıldırır A. Consensus paper on the evaluation and treatment of resistant hypertension by the Turkish Society of Cardiology. Anatol J Cardiol 2020; 24:137-152. [PMID: 32870176 PMCID: PMC7585974 DOI: 10.14744/anatoljcardiol.2020.74154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Asife Şahinarslan
- Department of Cardiology, Faculty of Medicine, Gazi University; Ankara-Turkey
| | - Emine Gazi
- Department of Cardiology, Faculty of Medicine, 18 Mart University; Çanakkale-Turkey
| | - Meryem Aktoz
- Department of Cardiology, Faculty of Medicine, Trakya University; Edirne-Turkey
| | - Çiğdem Özkan
- Department of Endocrinology, İzmir Bozyaka Training and Research Hospital; İzmir-Turkey
| | - Gülay Ulusal Okyay
- Department of Nephrology, Health Sciences University, Dışkapı Yıldırım Beyazıt Training and Research Hospital; Ankara-Turkey
| | | | - Erdal Belen
- Department of Cardiology, İstanbul Okmeydanı State Hospital; İstanbul-Turkey
| | - Atila Bitigen
- Department of Cardiology, Fatih Medical Park Hospital; İstanbul-Turkey
| | - Ülver Derici
- Department of Nephrology, Faculty of Medicine, Gazi University; Ankara-Turkey
| | | | - Aylin Yıldırır
- Department of Cardiology, Faculty of Medicine, Başkent University; Ankara-Turkey
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7
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Shahin MH, Rouby NE, Conrado DJ, Gonzalez D, Gong Y, Lobmeyer MT, Beitelshees AL, Boerwinkle E, Gums JG, Chapman A, Turner ST, Pepine CJ, Cooper-DeHoff RM, Johnson JA. β 2 -Adrenergic Receptor Gene Affects the Heart Rate Response of β-Blockers: Evidence From 3 Clinical Studies. J Clin Pharmacol 2019; 59:1462-1470. [PMID: 31090079 DOI: 10.1002/jcph.1443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/26/2019] [Indexed: 12/25/2022]
Abstract
β-Blockers' heart rate (HR)-lowering effect is an important determinant of the effectiveness for this class of drugs, yet it is variable among β-blocker-treated patients. To date, genetic studies have revealed several genetic signals associated with HR response to β-blockers. However, these genetic signals have not been consistently replicated across multiple independent cohorts. Here we sought to use data from 3 hypertension clinical trials to validate single-nucleotide polymorphisms (SNPs) previously associated with the HR response to β-blockers. Using linear regression analysis, we investigated the effects of 6 SNPs in 3 genes, including ADRB1, ADRB2, and GNB3, relative to the HR response following β-blocker used in the PEAR (n = 757), PEAR-2 (n = 368), and INVEST (n = 1401) trials, adjusting for baseline HR, age, sex, and ancestry. Atenolol was used in PEAR and INVEST, and metoprolol was used in PEAR-2. We found that rs1042714 and rs1042713 in ADRB2 were significantly associated with HR response to both β-blockers in whites (rs1042714 C-allele carriers, meta-analysis β = -0.95 beats per minute [bpm], meta-analysis P = 3×10-4 ; rs1042713 A-allele carriers, meta-analysis β = -1.15 bpm, meta-analysis P = 2×10-3 ). In conclusion, the results of our analyses provide strong evidence to support the hypothesis that rs1042714 and rs1042713 in the ADRB2 gene are important predictors of HR response to cardioselective β-blockade in hypertensive patient cohorts.
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Affiliation(s)
- Mohamed H Shahin
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Nihal El Rouby
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Daniela J Conrado
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Maximilian T Lobmeyer
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | | | - Eric Boerwinkle
- Human Genetics Center and Institute of Molecular Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - John G Gums
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Arlene Chapman
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Stephen T Turner
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Carl J Pepine
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, College of Medicine, Gainesville, FL, USA
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Division of Cardiovascular Medicine, Department of Medicine, University of Florida, College of Medicine, Gainesville, FL, USA
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Division of Cardiovascular Medicine, Department of Medicine, University of Florida, College of Medicine, Gainesville, FL, USA
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8
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Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, Egan BM, Flack JM, Gidding SS, Judd E, Lackland DT, Laffer CL, Newton-Cheh C, Smith SM, Taler SJ, Textor SC, Turan TN, White WB. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension 2019; 72:e53-e90. [PMID: 30354828 DOI: 10.1161/hyp.0000000000000084] [Citation(s) in RCA: 556] [Impact Index Per Article: 111.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. The antihypertensive drugs should be administered at maximum or maximally tolerated daily doses. RH also includes patients whose BP achieves target values on ≥4 antihypertensive medications. The diagnosis of RH requires assurance of antihypertensive medication adherence and exclusion of the "white-coat effect" (office BP above goal but out-of-office BP at or below target). The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH. This article is an updated American Heart Association scientific statement on the detection, evaluation, and management of RH. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP. If BP remains uncontrolled, referral to a hypertension specialist is advised.
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9
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Heart Rate in Hypertension: Review and Expert Opinion. Int J Hypertens 2019; 2019:2087064. [PMID: 30915238 PMCID: PMC6399539 DOI: 10.1155/2019/2087064] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/11/2019] [Accepted: 01/21/2019] [Indexed: 11/29/2022] Open
Abstract
Heart rate (HR) is strongly associated with both peripheral and central blood pressures. This association has implications in hypertension (HTN) prognosis and management. Elevated HR in HTN further elevates the risk of adverse outcomes. Evidence suggests that HR is an independent risk factor for cardiovascular (CV) and total mortality in patients with HTN. With objective to engage physicians and researchers in India to identify and discuss the implications related to HR management in HTN, experts in the HTN management provided consensus recommendations. The key expert recommendations included the following. (i) Heart rate (HR) has inverse relationship with the central aortic pressure, whereby reduction in HR is associated with an increase in central aortic pressure. This counter-balances the benefit of HR reduction with the harmful effects of rising central aortic pressure. (ii) Increase in the resting HR is associated with increased risk of incident HTN. A linear association between the two is observed especially in individuals with HR >80 bpm. (iii) A reduced HR variability further adds to the propensity for the development of HTN, especially in men. (iv) Each 10 beats per minute increase in the resting HR can substantially increase the risk of adverse CV and mortality outcomes. On treatment HR provides a better prognostic guide. (v) Ambulatory HR with day-time and night-time HR evaluation may also suggest different impact on outcomes. (vi) Target HR in patients with HTN remains unclear. Generally, HR<70 bpm on beta blocker (BB) treatment is advised which may be further lowered in patients with comorbidities like heart failure and coronary artery disease. (vii) Adopting healthy lifestyle approaches to keep check on BP and HR is essential. (viii) Use selective beta-1 blocker in symptomatic cases with elevated HR beyond 80-85 mmHg. BBs are expected to benefit by lowering HR by nearly 10 bpm. Preference should be given to newer beta-blockers which reduce HR and both peripheral and central blood pressure to derive comprehensive advantage of this dual action. (ix) It still remains unclear whether reducing HR in HTN without comorbidities alters the CV and mortality outcomes.
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10
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Stokke IM, Li ZB, Cicala S, Okin PM, Kjeldsen SE, Devereux RB, Wachtell K. Association of left bundle branch block with new onset abnormal wall motion in treated hypertensive patients with left ventricle hypertrophy: the LIFE Echo Sub-study. Blood Press 2019; 28:84-92. [PMID: 30698038 DOI: 10.1080/08037051.2019.1569463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS We aimed to investigate whether left bundle branch block (LBBB) is related to new-onset left ventricle (LV) wall motion abnormalities during treatment in hypertensive patients with electrocardiographic (ECG) defined left ventricular hypertrophy (LVH). METHODS AND RESULTS 960 patients with essential hypertension and ECG-LVH participating in the LIFE Echo Sub-study were investigated at baseline and annually with echocardiography, during randomized antihypertensive therapy. After excluding patients with LV wall motion abnormalities at baseline and patients developing new-onset LBBB during study time, we investigated 784 patients. The participants with (n = 32) and without (n = 752) LBBB were similar regarding most baseline variables. Logistic regression models controlling for LV mass index, Framingham risk score, and randomized treatment assignment were used to assess the odds ratio of developing new-onset abnormal LV wall motion on annual follow-up echocardiograms. The likelihood of developing new global LV wall motion abnormalities in patients with LBBB was not higher compared to those without LBBB except at year 5 (p = .002). The likelihood of developing new segmental LV wall motion abnormalities in patients with LBBB was however higher compared to patients without LBBB after 1 year (OR = 3.1, 95% CI = 0.7-14.2, p = .173); 2 years (OR = 6.9, 2.1-22.4, p = .003); 3 years (OR = 5.3, 2.0-14.3, p < .001), 4 years (OR = 4.0, 1.6-10.3, p = .003 and 5 years (OR = 4.1, 1.0-16.2, p = .394) of treatment. CONCLUSION Among patients with ECG-LVH, undergoing antihypertensive treatment, the presence of LBBB independently identifies individuals with ∼3- to 7-fold greater odds of developing new segmental abnormal LV wall motion. These findings suggest that LBBB may be a marker for progressive myocardial disease.
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Affiliation(s)
- Ildri M Stokke
- a Institute for Clinical Medicine, and Department of Cardiology , Oslo University Hospital, University of Oslo , Oslo , Norway
| | - Zhi Bin Li
- b Department of Medicine , Weill Cornell Medicine , New York , NY , USA
| | - Silvana Cicala
- c UOC di Cardiologia d'Emergenza con UTIC , Caserta , Italy
| | - Peter M Okin
- b Department of Medicine , Weill Cornell Medicine , New York , NY , USA
| | - Sverre E Kjeldsen
- a Institute for Clinical Medicine, and Department of Cardiology , Oslo University Hospital, University of Oslo , Oslo , Norway
| | | | - Kristian Wachtell
- a Institute for Clinical Medicine, and Department of Cardiology , Oslo University Hospital, University of Oslo , Oslo , Norway
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11
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Shahin MH, Conrado DJ, Gonzalez D, Gong Y, Lobmeyer MT, Beitelshees AL, Boerwinkle E, Gums JG, Chapman A, Turner ST, Cooper-DeHoff RM, Johnson JA. Genome-Wide Association Approach Identified Novel Genetic Predictors of Heart Rate Response to β-Blockers. J Am Heart Assoc 2018; 7:JAHA.117.006463. [PMID: 29478026 PMCID: PMC5866313 DOI: 10.1161/jaha.117.006463] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background For many indications, the negative chronotropic effect of β‐blockers is important to their efficacy, yet the heart rate (HR) response to β‐blockers varies. Herein, we sought to use a genome‐wide association approach to identify novel single nucleotide polymorphisms (SNPs) associated with HR response to β‐blockers. Methods and Results We first performed 4 genome‐wide association analyses for HR response to atenolol (a β1‐adrenergic receptor blocker) as: (1) monotherapy or (2) add‐on therapy, in 426 whites and 273 blacks separately from the PEAR (Pharmacogenomic Evaluation of Antihypertensive Responses) study. A meta‐analysis was then performed between the genome‐wide association analysis performed in PEAR atenolol monotherapy and add‐on therapy, in each race separately, using the inverse variance method assuming fixed effects. From this analysis, SNPs associated with HR response to atenolol at a P<1E‐05 were tested for replication in whites (n=200) and blacks (n=168) treated with metoprolol (a β1‐adrenergic receptor blocker). From the genome‐wide association meta‐analyses, SNP rs17117817 near olfactory receptor family10 subfamily‐p‐member1 (OR10P1), and SNP rs2364349 in sorting nexin‐9 (SNX9) replicated in blacks. The combined studies meta‐analysis P values for the rs17117817 and rs2364349 reached genome‐wide significance (rs17117817G‐allele; Meta‐β=5.53 beats per minute, Meta‐P=2E‐09 and rs2364349 A‐allele; Meta‐β=3.5 beats per minute, Meta‐P=1E‐08). Additionally, SNPs in the OR10P1 and SNX9 gene regions were also associated with HR response in whites. Conclusions This study highlights OR10P1 and SNX9 as novel genes associated with changes in HR in response to β‐blockers. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00246519.
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Affiliation(s)
- Mohamed H Shahin
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL
| | - Daniela J Conrado
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy University of North Carolina, Chapel Hill, NC
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL
| | - Maximilian T Lobmeyer
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL
| | | | - Eric Boerwinkle
- Human Genetics Center and Institute of Molecular Medicine, University of Texas Health Science Center, Houston, TX
| | - John G Gums
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL
| | | | - Stephen T Turner
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL
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Weber MA, Lackland DT. Contributions to Hypertension Public Policy and Clinical Practice: A Review of Recent Reports. J Clin Hypertens (Greenwich) 2016; 18:1063-1070. [DOI: 10.1111/jch.12902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Michael A. Weber
- State University of New York; Downstate College of Medicine; Brooklyn NY
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Li W, Yang J, Zhu XS, Li SC, Ho PC. Correlation between tea consumption and prevalence of hypertension among Singaporean Chinese residents aged ⩾40 years. J Hum Hypertens 2015; 30:11-7. [PMID: 26016594 DOI: 10.1038/jhh.2015.45] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/20/2015] [Accepted: 04/16/2015] [Indexed: 02/07/2023]
Abstract
By a cross-sectional epidemiology study, we attempted to correlate the consumption of tea and/or health supplements, living habits and socio-demographic factors to the prevalence of hypertension among Singaporean Chinese residents. Singaporean Chinese residents aged ⩾40 years were randomly selected and interviewed face-to-face by clinical research assistants. Hypertension was defined as measured systolic blood pressure at least 140 mm Hg and/or diastolic blood pressure at least 90 mmHg or self-reported history/treatment for hypertension. The prevalence of hypertension among the whole investigated population (N=1184, 58.27% females) was 49.73% and the prevalence increased to 66.47% in the sub-population aged ⩾60 years. High risk of hypertension was associated with age ⩾60 years (odds ratio (OR): 4.15-4.19, P<0.01), obesity (body mass index >25 kg m(-2), OR: 2.10-2.11, P<0.01), family history of hypertension (OR: 2.69-2.76, P<0.01), diabetes history (OR: 2.29-2.33, P<0.01), hyperlipidemia history (OR: 1.79-1.80, P<0.01), male (OR: 1.56-1.59, P<0.01) and coffee intake (OR: 1.44-1.46, P<0.05). In contrast, drinking green tea at least 150 ml per week was associated with lower hypertension risk (OR: 0.63, 95% confidence interval (CI): 0.43-0.91, P<0.05). Drinking combination of green tea and British tea was associated with higher reduction in the risk of hypertension (OR: 0.58, 95% CI: 0.39-0.85, P<0.05). This cross-sectional study suggests that consumption of tea, especially green tea and British tea, was associated with lowering the risk of hypertension. On the other hand, consumption of coffee could be a risk factor of hypertension. These findings may provide useful information for health promotion to reduce risk of hypertension and warrant further study to confirm and elucidate such association.
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Affiliation(s)
- W Li
- Singapore College of Traditional Chinese Medicine, Singapore, Singapore.,Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - J Yang
- National University Hospital of Singapore, Singapore, Singapore
| | - X S Zhu
- Centre for Complementary Medicine Research, University of Western Sydney, Sydney, New South Wales, Australia
| | - S C Li
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia
| | - P C Ho
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
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Jiang B, Han X, Wang L, Dong Q. Prognosis of Early-Stage Continuous Electrocardiogram Abnormalities on Patients with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2015; 24:1761-7. [PMID: 25939863 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/24/2015] [Accepted: 03/30/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND To explore the effects of onset time of electrocardiogram (ECG) abnormalities at an early stage of acute ischemic stroke on patient prognosis. Cardiac dysfunction after stroke is a challenge for clinicians. This is a retrospective study of patients in the neurology departments of 23 hospitals in Shanghai and Wuhan, China. METHODS The medical records of 351 patients were compared. Chi-square, Kruskal-Wallis, Mann-Whitney U tests, and stratification compared subgroups. Logistic regressions analyzed factors associated with modified Rankin Scale (mRS) score. RESULTS ECG abnormalities occurred in 70.1% of patients at an early stage (most were within 48 hours of disease onset) at least once, whereas 45.9% of the patients had ECG abnormalities within 48 hours of onset and at 7 days after onset. The incidence of poor prognosis (mRS >1) was significantly higher in the patients with ECG abnormalities for both time points than that in those with normal ECGs (56.3% versus 32%, odds ratio = 2.166). Most patients demonstrated 1 to 2 ECG abnormalities, and very few patients had 3 or more. Increasing number of ECG abnormalities was mirrored by poorer prognosis. ECG abnormalities occurred within 48 hours and at the seventh day after onset of acute ischemic stroke; the abnormalities that appeared within 48 hours and were still found on the seventh day after onset of the disease were independent predictors of poor patient prognosis. CONCLUSIONS The incidence of abnormal ECGs was high in the patients with acute ischemic stroke, and the abnormal ECGs could appear at any stage of the disease.
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Affiliation(s)
- Beisi Jiang
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Xiang Han
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Liang Wang
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China.
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Greve AM, Bang CN, Berg RMG, Egstrup K, Rossebø AB, Boman K, Nienaber CA, Ray S, Gohlke-Baerwolf C, Nielsen OW, Okin PM, Devereux RB, Køber L, Wachtell K. Resting heart rate and risk of adverse cardiovascular outcomes in asymptomatic aortic stenosis: the SEAS study. Int J Cardiol 2014; 180:122-8. [PMID: 25438232 DOI: 10.1016/j.ijcard.2014.11.181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/07/2014] [Accepted: 11/23/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND An elevated resting heart rate (RHR) may be an early sign of cardiac failure, but its prognostic value during watchful waiting in asymptomatic aortic stenosis (AS) is largely unknown. METHODS RHR was determined by annual ECGs in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study of asymptomatic mild-to-moderate AS patients. Primary endpoint in this substudy was major cardiovascular events (MCEs) and secondary outcomes its individual components. Multivariable Cox-models using serially-measured RHR were used to examine the prognostic impact of RHR per se. RESULTS 1563 patients were followed for a mean of 4.3years (6751 patient-years of follow-up), 553 (35%) MCEs occurred, 10% (n=151) died, including 75 cardiovascular deaths. In multivariable analysis, baseline RHR was independently associated with MCEs (HR 1.1 per 10min(-1) faster, 95% CI: 1.0-1.3) and cardiovascular mortality (HR 1.3 per 10min(-1) faster, 95% CI: 1.0-1.7, both p≤0.03). Updating RHR with annual in-study reexaminations, time-varying RHR was highly associated with excess MCEs (HR 1.1 per 10min(-1) faster, 95% CI: 1.1-1.3) and cardiovascular mortality (HR 1.4 per 10min(-1) faster, 95% CI: 1.2-1.7, both p≤0.006). The association of RHR with MCEs and cardiovascular mortality was not dependent on atrial fibrillation status (both p≥0.06 for interaction). CONCLUSIONS RHR is independently associated with MCEs and cardiovascular death in asymptomatic AS (Clinicaltrials.gov; unique identifier NCT00092677).
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Affiliation(s)
- Anders M Greve
- Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark.
| | - Casper N Bang
- Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Ronan M G Berg
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark
| | | | - Anne B Rossebø
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Kurt Boman
- Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Skelleftå, Sweden
| | - Christoph A Nienaber
- Department of Cardiology and Angiology, University Heart Center Rostock, Rostock School of Medicine, Rostock, Germany
| | - Simon Ray
- Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | | | | | - Peter M Okin
- Weill Cornell Medical College, New York, NY, United States
| | | | - Lars Køber
- Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Kristian Wachtell
- Weill Cornell Medical College, New York, NY, United States; Glostrup University Hospital, Copenhagen, Denmark
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O Hartaigh B, Gaksch M, Kienreich K, Grübler MR, Verheyen N, März W, Tomaschitz A, Gill TM, Pilz S. Associations of daytime, nighttime, and 24-hour heart rate with four distinct markers of inflammation in hypertensive patients: the Styrian Hypertension Study. J Clin Hypertens (Greenwich) 2014; 16:856-61. [PMID: 25266946 DOI: 10.1111/jch.12420] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/25/2014] [Accepted: 07/27/2014] [Indexed: 11/27/2022]
Abstract
The current study assessed which measure of heart rate (HR) is most associated with inflammatory activity. Among 368 hypertensive patients (mean age±standard deviation, 60.6±10.8; 52.9% women), mean daytime (from 6 am to 10 pm), nighttime (from 10 pm to 6 am), and 24-hour HR were recorded using a continuous 24-hour ambulatory blood pressure monitoring portable device. Associations of daytime, nighttime, and 24-hour HR with leukocytes, platelets, C-reactive protein (CRP), and 25-hydroxyvitamin D were calculated using multivariate linear regression, reporting unstandardized coefficients (B) with standard errors (SEs). Mean daytime, nighttime, and 24-hour HR were 73, 64, and 71 beats per minute, respectively. All HR measures were positively associated with leukocytes after adjustment. Nighttime HR was additionally related with higher CRP. When all HR measures were simultaneously added to a single multivariate model, only the positive associations of nighttime HR with leukocytes (B [SE]=0.06 [0.03], P=.04), as well as with CRP (B [SE]=0.20 [0.07], P=.005), persisted. Nighttime HR was more closely associated with inflammatory activity. These observations lend some insight toward the pathophysiological mechanisms that implicate HR in cardiovascular risk and provide valuable direction for forthcoming investigations.
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Affiliation(s)
- Bríain O Hartaigh
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY; Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, Adler Geriatric Center, New Haven, CT
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Drug-resistant hypertensive patients responding to multielectrode renal denervation exhibit improved heart rate dynamics and reduced arrhythmia burden. J Hum Hypertens 2014; 28:587-93. [PMID: 24621623 DOI: 10.1038/jhh.2014.14] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/10/2014] [Accepted: 01/27/2014] [Indexed: 02/07/2023]
Abstract
Transluminal renal sympathetic denervation (RDN) reduces blood pressure (BP) in patients with drug-resistant uncontrolled hypertension. We assessed the effect of RDN on heart rate, supraventricular and ventricular ectopic activity and indexes of heart rate variability in 14 patients with drug-resistant uncontrolled hypertension who were all responders to RDN (defined as a reduction in office systolic BP ⩾ 10 mm Hg) at baseline and at 1 and 6 months after the procedure using the multielectrode EnligHTN ablation catheter (St Jude Medical). Office and 24-h systolic and diastolic BP were significantly reduced both at 1 and 6 months after RDN and all patients were office BP responders. There was a trend toward office heart rate reduction (by 6.9 b.p.m., P=0.064) at 1 month and a significant reduction by 10 b.p.m. (P=0.004) at 6 months. Mean 24-h Holter monitoring heart rate was reduced by 6.7 b.p.m. (P=0.022) at 1 month and by 5.3 b.p.m. (P=0.010) at 6 months after RDN. The total number of premature supraventricular and ventricular contractions was significantly decreased and time- and frequency- domain indexes were increased both at 1 and at 6 months after RDN (P<0.05 for both cases). Apart from the substantial BP lowering, RDN results in significant reduction of mean heart rate and arrhythmia burden, restoring autonomic balance in responder patients with drug-resistant uncontrolled hypertension.
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Böhm M, Cotton D, Foster L, Custodis F, Laufs U, Sacco R, Bath PMW, Yusuf S, Diener HC. Impact of resting heart rate on mortality, disability and cognitive decline in patients after ischaemic stroke. Eur Heart J 2012; 33:2804-12. [PMID: 22922507 DOI: 10.1093/eurheartj/ehs250] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
AIMS Recurrent stroke is a frequent and disabling event. A high heart rate is associated with cardiovascular outcomes. We investigated the effects of the resting heart rate on cardiovascular and neurological outcomes after recurrent stroke in the high-risk population of the PRoFESS study. METHODS AND RESULTS A total of 20,165 patients after ischaemic stroke (mean age 66.1, SD 8.6 years) assigned to the treatment arms of the PRoFESS trial were pooled divided by quintiles of the baseline heart rate and analysed according to cardiovascular and functional outcomes after stroke: recurrent stroke and major cardiovascular outcomes such as stroke, myocardial infarction, and worsening or new-onset heart failure as well as death from cardiovascular and non-cardiovascular causes. Pre-defined endpoints were disability after a recurrent stroke, assessed with the modified Rankin scale (mRS) and the Barthel index at 3 months, and cognitive function, assessed with the Mini-Mental State Examination (MMSE) score at 4 weeks after randomization and at the penultimate visit. Patients in the two highest quintiles of heart rate (77-82 and >82 b.p.m.) were at a higher risk for total death [hazard ratio (HR) 1.42, 95% CI 1.19-1.69 and HR 1.74, 95% CI 1.48-2.06, P < 0.0001] compared with the lowest quintile. Similar results were observed for vascular death [71-≤76 b.p.m., HR 1.39 (1.11-1.74), P < 0.0001] and non-vascular death [from >82 b.p.m., HR 1.66 (1.29-2.13), P = 0.0016]. Myocardial infarction (P = 0.7084) and recurrent stroke (P = 0.1379) were not significantly associated with the baseline heart rate. Hazard ratios were adjusted to multiple confounders including the baseline blood pressure. In the group of patients with a recurrent stroke, an association of a lower heart rate to better outcomes was measured with the Barthel index across all heart rate groups. In addition, there was a significant association of the baseline heart rate to the occurrence of significant cognitive decline according to an MMSE score ≤24 points at 1 month and at the penultimate visit or a decline of ≥2 points between these two time periods. Better independence score at a low heart rate were observed. CONCLUSION The heart rate is a risk indicator for mortality in patients with stroke and, importantly, a low heart rate is associated with a better functional outcome and less cognitive decline after an ischaemic stroke. TRIAL REGISTRATION ClinicalTrials.gov, number NTC00153062.
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Affiliation(s)
- Michael Böhm
- Universitätskliniken des Saarlandes, Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Kirrberger Str. 1, D 66424 Homburg/Saar, Germany.
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Kjeldsen SE, Okin PM. High resting heart rate predicts mortality, disability, and cognitive decline in patients after ischaemic stroke: time for additional selective I(f) channel inhibitor trials? Eur Heart J 2012; 33:2761-3. [DOI: 10.1093/eurheartj/ehs260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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