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Response to Intervisit Blood Pressure Variability and Outcome: Is Heart Rate a Missing Confounder?
P Muntner... - Hypertension, 2011 - Am Heart Assoc It is well established that antihypertensive medication classes affect heart rate and that heart
rate is associated with mortality. 2,3 As it relates to our study, 4 heart rate is an important determinant
of blood pressure regulation and, thus, may be associated with visit-to-visit variability of ...
It is well established that antihypertensive medication classes affect heart rate and that heart rate is associated with mortality.2,3 As it relates to our study,4 heart rate is an important determinant of blood pressure regulation and, thus, may be associated with visit-to-visit variability of blood pressure.5 Although an association has been demonstrated between heart rate variability and blood pressure variability, few data are available on heart rate levels and blood pressure variability.6 However, such an association seems plausible. If heart rate is associated with visit-to-visit variability of blood pressure, it may confound the relation with mortality that we reported.
On the basis of this hypothesis, we revisited the Third National Health and Nutrition Examination Survey mortality follow-up data. Heart rate was obtained via standard 12-lead electrocardiograms for a subsample of 543 of the 954 participants included in our analyses (ie, those ≥40 years of age at baseline). The mean heart rates were 67.9, 67.7, and 67.4 from lowest to highest tertile of SD of systolic blood pressure (P for trend=0.685). When limited to individuals taking antihypertensive medication, no association was present between heart rate and visit-to-visit variability of blood pressure. Importantly, adjustment for heart rate did not alter the relationship between higher SD of systolic blood pressure and all-cause mortality that we reported in the original article. Specifically, the multivariable-adjusted (including heart rate) hazard ratios for all-cause ...
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Response to Intervisit Blood Pressure Variability and Outcome: Is Heart Rate a Missing Confounder? |
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