The impact of delayed heart rate recovery on prevalent hypertension

ABSTRACT

Objectives: Delayed heart rate recovery (HRR) is considered an indicator of autonomic nervous dysfunction, which is a primary pathological mechanism of hypertension. The present study aimed to explore the independent association between delayed HRR and prevalent hypertension.

Methods: In this cross-sectional study, 314 inpatients were recruited between January 2018 and December 2019. HRR was defined as the peak heart rate during exercise minus the 2^nd-minute heart rate after exercise in the treadmill exercise test.

Results: The mean HRR in the hypertension group was lower than that in the non-hypertension group (41 bpm vs. 46 bpm; P < 0.001). After full adjustment, each standard deviation increase in HRR was associated with a 35% decrease in the risk of prevalent hypertension (OR: 0.65, 95% CI: 0.48–0.87; P = 0.004). When the HRR was divided into quartiles, the risk in the top quartile was 26% of that in the bottom quartile (OR: 0.26, 95% CI: 0.12–0.56; P = 0.001). Furthermore, smooth curve fitting showed that the risk of prevalent hypertension decreased linearly with the increase in HRR.

Conclusion: Delayed HRR was independently associated with prevalent hypertension. The association was linear and robust over the entire range of HRR. The present study suggested that delayed HRR could be used to optimize hypertension risk stratification.

KEYWORDS:

• Hypertension
• heart rate recovery
• autonomic nervous dysfunction
• treadmill exercise test

Acknowledgments

We thank staff from the Department of Electrocardiogram in the Fourth Affiliated Hospital, Zhejiang University School of Medicine. Thanks for their accurate work with the treadmill exercise test.

Authors’ contributions

JL and GXG were responsible for the concept and design of the study. JL, WRS, YD and YPJ were responsible for the study coordination and conduct. JL collected and analyzed the data. JL, WRS and GXG drafted and reviewed the manuscript. JL, WRS interpreted the data. All authors read and approved the final manuscript.

Data availability statement

The datasets used and analyzed during this study are available from the corresponding author on reasonable request.

Declaration of interest

No potential conflict of interest was reported by the authors.

Declaration of financial/other relationships

The authors report no conflicts of interest.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethics approval and consent to participate

The study has been approved by the Human Research Ethics Committee of the Fourth Affiliated Hospital, Zhejiang University School of Medicine (Approval NO.:K2020054). The consent was applied for exemption since the medical records and biological specimens used in this study were obtained from previous clinical diagnosis and treatment.

Additional information

Funding

The Key Projects of Zhejiang Medical and Health Science and Technology Plan (Provincial and Ministerial Co-construction) [No. WKJ-ZJ-1819]; and the Fundamental Research Funds for the Zhejiang Province Universities [No. 2019XZZX003-15].