Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease: findings from the INternational VErapamil-SR/trandolapril STudy (INVEST)
Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease: findings from the INternational VErapamil-SR/trandolapril STudy (INVEST)
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DOI：
10.1093/eurheartj/ehn123
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发表时间：
2008-05-01
影响因子：
39.3
通讯作者：
Pepine, Carl J.
中科院分区：
文献类型：
--
作者：
Kolloch, Rainer;Legler, Udo F.;Pepine, Carl J.
目的探讨不同降压策略的冠心病(CAD)患者静息心率(RHR)与不良结局的关系。方法与结果在国际维拉帕米-SR/Trandolapril研究(INSTEST)患者中，随机分为维拉帕米-SR(Ve)和阿替洛尔(At)两组，评估不良结局(死亡、非致命性心肌梗死或非致死性卒中)发生的时间以及基线和随访RHR的预测值。较高的基线和随访RHR与不良结局风险增加相关，基线RHR与随访RHR呈线性关系，随访RHR呈J型关系。虽然随访的RHR与不良结局独立相关，但与心力衰竭和糖尿病等基线条件相比，它增加的额外风险较少。At策略降低RHR超过Ve(24个月时，69.2vs.72.8次/分钟；P<；0.001)，但不良结果相似[Ve9.67%(35/1000病人年)vs.9.88%(36/1000病人年，可信区间0.90-1.06，P=0.62)]。结论在合并高血压的冠心病患者中，RHR可预测不良结局，且正在治疗的RHR比基线RHR更能预测不良结局。在降低RHR方面，VE策略不如AT策略有效，但对不良后果的影响相似。
Aim To determine the relationship between resting heart rate (RHR) and adverse outcomes in coronary artery disease (CAD) patients treated for hypertension with different RHR-lowering strategies.Methods and results Time to adverse outcomes (death, non-fatal myocardial infarction, or non-fatal-stroke) and predictive values of baseline and follow-up RHR were assessed in INternational VErapamil-SR/trandolapril STudy (INVEST) patients randomized to either a verapamil-SR (Ve) or atenolol (At)-based strategy. Higher baseline and follow-up RHR were associated with increased adverse outcome risks, with a linear relationship for baseline RHR and J-shaped relationship for follow-up RHR. Although follow-up RHR was independently associated with adverse outcomes, it added less excess risk than baseline conditions such as heart failure and diabetes. The At strategy reduced RHR more than Ve (at 24 months, 69.2 vs. 72.8 beats/min; P < 0.001), yet adverse outcomes were similar [Ve 9.67% (rate 35/1000 patient-years) vs. At 9.88% (rate 36/1000 patient-years, confidence interval 0.90-1.06, P = 0.62)]. For the same RHR, men had a higher risk than women.Conclusion Among CAD patients with hypertension, RHR predicts adverse outcomes, and on-treatment RHR is more predictive than baseline RHR. A Ve strategy is less effective than an At strategy for lowering RHR but has a similar effect on adverse outcomes.