• Piotr Sobieraj, Maciej P Siński, and Jacek Lewandowski.
• Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
• Pol. Arch. Med. Wewn. 2023 Mar 29; 133 (3).

IntroductionThe predictive value of heart rate (HR) assessed using an automated office blood pressure measurement (AOBPM) remains unknown.ObjectivesThis study aimed to determine the impact of AOBPM HR on the risk of cardiovascular events in hypertensive patients with and without prior cardiovascular disease (CVD).Patients And MethodsData of 9361 participants of the Systolic Blood Pressure Intervention Trial (median follow‑up, 3.26 years) were used to perform a post hoc analysis based on baseline AOBPM HR levels (<50, 50-60, 60-70, 70-80, and >80 bpm). Clinical composite end point (CE) was defined as myocardial infarction (MI), acute coronary syndrome other than MI, heart failure exacerbation, stroke, or cardiovascular death. Cardiovascular‑related and all‑cause mortalities were also evaluated.ResultsA total of 1877 participants with and 7484 individuals without CVD were included. Those with higher baseline HR were less frequently men and more often smokers, had higher body mass index and estimated glomerular filtration rate, lower baseline systolic blood pressure, and higher diastolic blood pressure. No differences were observed in the CE frequency, its components, and all‑cause death between the baseline HR groups. Elevated HR (>70 bpm) was associated with a higher risk of CE, MI, and cardiovascular death in a multivariable Cox model. Moreover, the model determining the MI risk showed a J‑shaped relationship with HR and a significant interaction term (P = 0.049) between HR and CVD history.ConclusionsHigh AOBPM HR is associated with a higher risk of cardiovascular events and mortality, whereas low HR may result in higher MI risk in patients with previous CVD.

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