Predictive Value of Clinic and Ambulatory Heart Rate for Mortality in Elderly Subjects With Systolic Hypertension

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Abstract
SEVERAL EPIDEMIOLOGIC studies have shown that some major risk factors for atherosclerosis such as total cholesterol level and smoking status tend to lose their predictive power for morbidity and mortality in old age.1-4 In recent years, evidence has been accumulating that high heart rate is an important risk factor for cardiovascular and noncardiovascular death in middle-aged5-9 as well as in elderly10,11 normotensive subjects. Much less is known about whether heart rate is a risk factor for mortality also in hypertensive individuals because only a few studies have examined this relationship in the hypertensive segment of 2 populations,12,13 and to the best of our knowledge, no study has been conducted in elderly subjects with hypertension. Another point that needs to be clarified is whether there are sex differences in the impact of a potentially modifiable risk factor such as heart rate on mortality in hypertensive individuals. In the Framingham Study, a significant association between heart rate and mortality was found in men and women with hypertension.12 In contrast, the more recent study by Benetos et al13 found a relationship between heart rate and mortality among men but not women with hypertension.