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Heart rate and heart rate variability in resistant versus controlled hypertension and in true versus white-coat resistance

Journal of Human Hypertension volume 28, pages 416–420 (2014)Cite this article

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Abstract

Sympathetic nervous system has an important role in resistant hypertension. Heart rate (HR) is a marker of sympathetic activity, but its association with resistant hypertension has not been assessed. We aimed to evaluate differences in HR values and variability between resistant and controlled patients and between true and white-coat resistant hypertensives (RHs). We compared office and ambulatory HR, nocturnal dip and s.d. in 14 627 RHs versus 11 951 controlled patients (on ⩽3 drugs) and in 8730 true (24 h blood pressure (BP)⩾130 and/or 80 mm Hg) versus 4825 white-coat (24-h BP<130/80 mm Hg) RHs. After adjusting for age, gender, body mass index, diabetes status and beta blocker use, HR values and variability were significantly elevated in resistant versus controlled patients and in true versus white-coat RHs. In logistic regression models, after adjustment for confounders, office HR (odds ratio for each increase in tertile: 1.337; 95% confidence interval: 1.287–1.388; P<0.001), nocturnal dip (0.958; 0.918–0.999; P=0.035) and night time s.d. (1.115; 1.057–1.177; P=0.013) were all significantly associated with the presence of resistant hypertension. Moreover, night time HR (1.160; 1.065–1.265; P<0.001), nocturnal dip (0.876; 0.830–0.925; P<0.001) and 24-h s.d. (1.148; 1.092–1.207; P<0.001) were all significantly associated with true resistant hypertension. In conclusion, both increased HR and variability are associated with resistant hypertension and with true resistance. These suggest the involvement of the sympathetic nervous system in the development of resistance to antihypertensive treatment.

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Acknowledgements

We thank all the participants of the Spanish ABPM Registry. Their names are available at www.cardiorisc.com. The Spanish ABPM Registry was initiated and is maintained by an unrestricted grant from Lacer Laboratories, Spain. The present analysis has been partially funded by an official grant from the Spanish Health Authority (PI10/01011).

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Authors and Affiliations

  1. Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Terrassa, Spain

    A de la Sierra

  2. Division of cardiovascular disease, University of Alabama, Birmingham, AL, USA

    D A Calhoun

  3. CAP la Mina, University of Barcelona, San Adrian del Besos, Spain

    E Vinyoles

  4. Department of Preventive Medicine and Public Health, Autonomous University, Madrid, Spain

    J R Banegas & J J de la Cruz

  5. Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo, Spain

    M Gorostidi

  6. Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain

    J Segura & L M Ruilope

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  1. A de la Sierra
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  2. D A Calhoun
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  7. J Segura
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Correspondence to A de la Sierra.

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de la Sierra, A., Calhoun, D., Vinyoles, E. et al. Heart rate and heart rate variability in resistant versus controlled hypertension and in true versus white-coat resistance. J Hum Hypertens 28, 416–420 (2014). https://doi.org/10.1038/jhh.2013.135

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