Predictive value of clinic and ambulatory heart rate for mortality in elderly subjects with systolic hypertension

Objective: To examine the association of clinic and ambulatory heart rate with total, cardiovascular, and non-cardiovascular death in a cohort of elderly subjects with isolated systolic hypertension from the Systolic Hypertension in Europe Trial. Methods: A total of 4682 patients participated, whose untreated blood pressure on conventional measurement at baseline was 160 to 219 mm Hg systolic and lower than 95 mm Hg diastolic. Clinic heart rate was the mean of 6 readings during 3 visits. Ambulatory heart rate was recorded with a portable intermittent technique in 807 subjects. Results: Raised baseline clinic heart rate was positively associated with a worse prognosis for total, cardiovascular, and noncardiovascular mortality among the 2293 men and women taking placebo. Subjects with heart rates higher than 79 beats/min (bpm) (top quintile) had a 1.89 times greater risk of mortality than subjects with heart rate lower than or equal to 79 bpm (95% confidence interval, 1.33-2.68 bpm). in a Cox regression analysis, predictors of time to death were heart rate (P < .001), age (P < .001), serum creatinine level (P = .001), presence of diabetes (P = .002), previous cardiovascular disease (P = .01), triglyceride readings (P = .02), smoking (P = .04), and elevated systolic blood pressure (P = .05), while total cholesterol level was found to be nonsignificant in the model. In the ambulatory monitoring subgroup, clinic and ambulatory heart rates predicted noncardiovascular but not cardiovascular mortality. However, in a Cox regression analysis in which clinic and ambulatory heart rates were included, a significant association with noncardiovascular mortality was found only for clinic heart rate (P = .004). In the active treatment group, the weak predictive power of clinic heart rate for mortality disappeared after adjustment for confounders. Conclusions: In untreated older patients with isolated systolic hypertension, a clinic heart rate greater than 79 bpm was a significant predictor of all-cause, cardiovascular, and noncardiovascular mortality. Ambulatory heart rate did not add prognostic information to that provided by clinic heart rate.