A nonlinear association between resting heart rate and ischemic stroke among community elderly hypertensive patients

ABSTRACT

Background: Ischemic stroke is a major public health problem and a main cause of death in China. However, how resting heart rate may associate with ischemic stroke among patients with hypertension remains unclear.

Objective: To investigate the association between resting heart rate and ischemic stroke among elderlies with hypertension in China.

Methods: We conducted a retrospective study of elderlies with hypertension who aged ≥60 years and were free from a stroke at baseline. Resting heart rate at baseline was treated as both continuous and categorical variable. Hazard ratios for ischemic stroke were estimated by multivariate Cox proportional hazards models.

Results: A total of 3071 elderlies with hypertension [1369 (44.6%) men, an average age of 71.3 ± 7.1 years] were enrolled, and 182 cases of ischemic stroke occurred during a mean follow-up period of 5.5 years. Multivariate Cox regression showed that every 10 bpm increment in resting heart rate elevated the risk of ischemic stroke by 21% (95%CI: 1.05, 1.73; P = 0.018). After adjusting for confounders, resting heart rate ≥90 bpm significantly associated with the risk of ischemic stroke (HR: 1.35, 95% CI = 1.16, 2.78) when using the resting heart rate <60 bpm as a referent. Subgroup analysis showed that the relation between resting heart rate and risk of ischemic stroke was seem to be stronger in female (HR: 1.32 vs 1.11), those with uncontrolled hypertension (HR: 1.32 vs 1.12), people with combined diabetes and hypertension (HR: 1.31 vs 1.12), people with overweight (HR: 1.39 vs 1.02) and those who aged >75 (HR: 1.33 vs 1.11). Smoothing spline plots suggested the optimal resting heart rate for the lowest risk of ischemic stroke was between 60 and 80 bpm.

Conclusions: In Chinese elderly hypertensive patients, elevated resting heart rate was an independent predictor of ischemic stroke, and the optimal resting heart rate was around 70 bpm.

KEYWORDS:

• Resting heart rate
• ischemic stroke
• elderly hypertension
• China

Declarations of interest

The authors declared no conflict of interest.

Reviewer disclosure

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

Additional information

Funding

This work was supported by the Science and Technology Program of Guangzhou [No.201604020143, No.201604020018, No.201604020186, and No.201803040012], the National Key Research and Development Program of China [No.2017YFC1307603, No.2016YFC1301305, and No.2017YFC0909303] and the Key Area R&D Program of Guangdong Province [No.2019B020227005].The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript