American Journal of Hypertension Advance Access published September 16, 2013
ORIGINAL ARTICLE
Delayed Heart Rate Recovery is Strongly Associated With Early and Late-Stage Prehypertension During Exercise Stress Testing
BACKGROUND Heart rate recovery (HRR) has been shown to predict cardiovascular disease mortality. HRR is delayed in hypertension, but its association with prehypertension (PHT) has not been well studied. METHODS The study population consisted of 683 asymptomatic individuals (90% men, aged 47 ± 7.9 years). HRR was defined as peak heart rate minus heart rate after a 2-minute rest. PHT was categorized into stage I (systolic blood pressure (SBP) 120–129 mm Hg or diastolic BP (DBP) 80–84 mm Hg) or stage II (SBP 130–139 mm Hg or DBP 85–89 mm Hg). Logistic regression was used to generate odds ratios (ORs) for the relationship between HRR and PHT. RESULTS The mean HRR was lower in the PHT groups than in those who were normotensive (60 bpm and 58 bpm in stages I and II PHT vs. 65 bpm
in normal BP; P 20 years is about 27%,5 and the 4-year risk of progression from PHT to hypertension is between 17.6% in those with early PHT (SBP 120–129 mm Hg or DBP 80–84 mm Hg) and 37.3% in those with late PHT (SBP 130–139 mm Hg or DBP 85–89 mm Hg).6 PHT has been associated with several markers of cardiovascular risk including microalbuminuria,5 elevated uric acid, total cholesterol, low-density lipoprotein cholesterol
(LDL-C), fasting plasma glucose, and reduced high-density lipoprotein cholesterol (HDL-C).7–10 Findings from the Framingham Heart Study suggest that autonomic dysfunction, as measured by heart rate variability, might be implicated in the development of hypertension.11 However, the pathogenetic mechanisms underlying PHT development remain unclear. Recently, associations between autonomic dysfunction and PHT have been made.12–15 These include overactivity of the sympathetic nervous system and cardiac parasympathetic dysfunction. Heart rate recovery (HRR) after exercise is a useful marker of cardiac parasympathetic function.16 It is measured as the difference between the peak heart rate during exercise and the heart rate at an interval after the end of the exercise, usually 30 seconds or 1,
Correspondence: Khurram Nasir (
[email protected]).
1Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida; 2The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; 3Department of Medicine, Herbert Wertheim College of Medicine, Miami, Florida; 4Preventive Medicine Center Hospital Israelita Albert Einstein, Sao Paulo, Brazil; 5Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida; 6Baptist Cardiac and Vascular Institute, Miami, Florida; 7Heart Institute (InCor) University of São Paulo Medical School Hospital, Sao Paulo, Brazil.
Initially submitted April 23, 2013; date of first revision August 16, 2013; accepted for publication August 16, 2013.
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American Journal of Hypertension
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Ehimen Aneni,1 Lara L. Roberson,1 Sameer Shaharyar,1 Michael J. Blaha,2 Arthur A. Agatston,1,3 Roger S. Blumenthal,2 Romeu S. Meneghelo,4 Raquel D. Conceiçao,4 Khurram Nasir,1,2,3,5,6 and Raul D. Santos4,7
Aneni et al.
2, or 4 minutes. Delay in HRR after exercise has repeatedly been shown to be associated with all-cause cardiovascular mortality.17–22 However, studies examining the association between HRR after exercise and PHT are scant. The only study we found showed that the prevalence of delayed HRR (
