Home Heart Rate Research Articles

P076 FACTORS INFLUENCING POST-COVID HOME BP AND HR FLUCTUATION WITHIN THE URBAN INDIAN DIABETIC POPULATION

Objective: The impact of COVID-19 on cardiovascular health among adult diabetics remains underexplored, particularly concerning home blood pressure (BP) and heart rate (HR) variability. This study aims to elucidate the factors influencing post-COVID home BP and HR fluctuation within the urban Indian diabetic population. Design and Methods: A cross-sectional study was conducted, involving 1000 adult diabetic patients aged 30 to 80 years with prior COVID-19 infection. Home BP and HR readings were recorded twice daily over seven days, generating 28 measurements. Variability in BP and HR was determined using standard deviation calculations between morning and evening readings, as well as between consecutive measurements. Results: Older age (OR: 1.56, 95% CI: 1.23-1.98), cardiovascular comorbidities (OR: 2.09, 95% CI: 1.67-2.62), diabetes (OR: 1.84, 95% CI: 1.43-2.36), and elevated home BP (OR: 2.35, 95% CI: 1.87-2.95) emerged as independent predictors of increased morning-to-evening home BP variability. Similarly, older age (OR: 1.72, 95% CI: 1.34-2.21) and elevated home BP (OR: 2.14, 95% CI: 1.67-2.75) were determinants of heightened day-to-day BP variability, while a combination of older age (OR: 1.98, 95% CI: 1.52-2.58), female sex (OR: 1.43, 95% CI: 1.11-1.84), cardiovascular disease (OR: 1.89, 95% CI: 1.47-2.44), and elevated home BP (OR: 2.56, 95% CI: 1.98-3.31) predicted greater variability between consecutive readings. Conversely, younger age (OR: 0.76, 95% CI: 0.59-0.98) and elevated home HR (OR: 1.92, 95% CI: 1.51-2.44) were associated with increased morning-versus-evening HR variability. Additionally, younger age (OR: 0.67, 95% CI: 0.51-0.88), female sex (OR: 1.34, 95% CI: 1.04-1.73), and elevated home HR (OR: 1.78, 95% CI: 1.39-2.29) were predictive of greater variability between consecutive HR measurements. Conclusion: Understanding the determinants of home BP and HR variability post-COVID infection is crucial for prognostication and clinical management. Clinicians should prioritize counseling incorporating regular home blood pressure measurements, diabetes management, and cardiovascular disease prevention, particularly for high-risk diabetic patients.

Heart rate from intermittent home measurements within an atrial fibrillation screening program is associated with mortality

Abstract Introduction A high resting heart rate is a predictor of cardiovascular disease and cardiovascular mortality. Studies on the association between heart rate and outcomes often measure heart rate at a single time point, even though multiple measurements may be a stronger predictor of cardiovascular risk. Indeed, the association between short-term home heart rate measurements and outcomes has not been extensively studied. Purpose This sub study of the STROKESTOP trial explores the association of baseline and home resting heart rate measurements with all-cause and cardiovascular mortality. Methods The STROKESTOP randomised controlled trial consisted of an atrial fibrillation (AF) screening program among the 75- and 76-year-old inhabitants of two Swedish regions. Participants in the intervention group were invited to a two week intermittent screening program, consisting of twice daily measurements with an ECG-based handheld device. For this sub analysis, baseline heart rate, the median of 5 home morning heart rates and the median of 5 home evening heart rates were evaluated. Associations were evaluated by heart rate quintiles (41-63 bpm, 64-70 bpm, 71-76 bpm, 77-84 bpm and ≥85 bpm), with 64-70 bpm as the reference category. Hazard rations were obtained by Cox regression analysis. The full multivariable model included demograhic factors such as sex and educational level, medical history of several diseases and the use of cardiovascular medication. Both all-cause mortality and cardiovascular mortality were evaluated. Results In total, 5873 individuals were included in this analysis. Overall, 55.6% were women and the median baseline heart rate was 73 [65-81] bpm, whereas the median of morning heart rates was 71 [64-78] bpm and that of evening heart rates 71 [65-79] bpm. Having a baseline heart rate in the highest quintile compared to the reference quintile, showed a hazard ratio (HR) for all-cause mortality in unadjusted analysis of 1.39 (1.11-1.73) (p=0.004), and of 1.51 (1.20-1.90) in the fully adjusted analysis (p<.001). For cardiovascular mortality, HRs were 1.78 (1.21-2.63) (p=0.004) and 2.13 (1.42-3.20) (p=<.001), respectively. The association between the highest heart rate and all-cause mortality and cardiovascular mortality were substantially strengthened when median morning heart rates were considered (HR 2.03 (1.61-2.56) and 2.18 (1.72-2.76), p<.001 for all-cause mortality on univariable and multivariable analysis, HR 2.35 (1.57-3.51) and 2.59 (1.72-3.92), p<.001) for cardiovascular mortality). Associations between home evening heart rates and all-cause and cardiovascular mortality were not substantially stronger compared to the associations with baseline heart rate. Conclusion Our study shows that home-measured morning heart rate is more strongly associated with all-cause and cardiovascular mortality compared to a single time-point office heart rate.Hazard ratios for mortality

EFFECTS OF ANGIOTENSIN RECEPTOR-NEPRILYSIN INHIBITOR (ARNI) ON HOME BLOOD PRESSURE AND BAPWV IN ESSENTIAL HYPERTENSIVE PATIENTS

Objective: Sacubitril/valsartan sodium hydrate (Entresto) is classified as an ARNI and has a novel mechanism of action that simultaneously inhibits neprilysin and angiotensin II receptors. We investigated the effects of Entresto on blood pressure (BP), baPWV, and carotid arterial intima-media thickness (IMT) and elasticity in essential hypertension. Design and method: Fifty-two hypertensive patients (twenty-six males, average age 67 years) who had insufficient BP reduction (home systolic 135 or diastolic 85 mmHg or higher) after receiving ARBs (azilsartan 26 or valsartan 26) for more than 6 months, were assigned to receive Entresto for 12 months (200-400mg/day, gradually increase depending on the condition). Changes in home BP, biochemical data, baPWV, central blood pressure (cSBP) were evaluated. The carotid arterial IMT and elastic modulus in the circumferential direction (Eθ) were simultaneously measured by the high-resolution Doppler technique, “Phased Tracking Method”. Results: Home morning BP (mmHg) after administration of Entresto significantly (p<0.05) decreased from 142.9±11.3/80.0±12.1 to 125.7±7.4/70.9±12.0, and home heart rate (HR, bpm) also significantly decreased from 75.1±11.3 to 72.2±11.9. There were no differences in BP and HR changes between ARBs. Furthermore, baPWV (m/sec) significantly decreased from 1542.4±259.8 to 1438.4±222.41, and cSBP (mmHg) significantly decreased from 141.0±9.1 to 133.2±8.4. Urine protein (mg/g/Cr) decreased significantly from 319.6±473.6 to 213.1±376.4, but there were no significant changes in eGFR (45.6±14.1 to 44.5±14.5 mL/min/1.73m2) nor serum potassium (4.2±0.4 to 4.0±0.9mEq/L). Eθ (kPa) was reduced significantly from 301±141 to 163±41 without changes in IMT. The histogram analysis of the Eθ data revealed the drug decreased harder components of the elasticity distribution, suggesting improvement of endothelial dysfunction. Conclusions: These data demonstrate that the ARNI, Entresto provides potent antihypertensive and antiatherosclerotic effects.

Monitoring of the regulatory ability and regulatory state of the autonomic nervous system and its application to the management of hypertensive patients: a study protocol for randomised controlled trials

IntroductionMany causes lead to sympathetic-vagus imbalance, which promotes the development of hypertension and accelerates the process of target organ damage. Many studies have shown that exercise training and heart rate...

PS-C11-2: FACTORS AFFECTING HOME BLOOD PRESSURE AND HEART RATE VARIABILITY POST-COVID INFECTION

Objective: There is a scarcity of data on the factors that influence home blood pressure (BP) and heart rate (HR) variability. This study was undertaken to determine the factors that influence home BP and HR fluctuation post COVID infection in the urban Indian population. Designs and Methods: We conducted a cross-sectional study among 1000 patients between the ages of 30 and 80 who were previously infected with COVID-19 infection, but not hospitalized. These patients were guided and trained to measure BP at home. BP and HR readings were taken at home twice a day, in the morning and evening, for seven days (28 measurements). The SD of morning minus evening, and first minus second readings was used to calculate BP and HR variability. Results: Old age, cardiovascular illness, diabetes, and high home blood pressure were all found to be independent predictors of an increased morning than evening home blood pressure variability. Old age, and high home blood pressure were all independent determinants of greater day-to-day home blood pressure variability, while old age, female sex, cardiovascular disease, and high home blood pressure were all independent determinants of greater first versus second home blood pressure variability. Young age, and high home HR, on the other hand, were all independent drivers of increased morning vs evening variability. Young age, female sex, and a high home HR were also independent predictors of first versus second home HR variability. Conclusion: Considering home BP and HR fluctuation have prognostic value, it is critical for clinicians to understand the underlying reasons for these variables. Doctors should focus on alcohol, diabetes, and cardiovascular disease prevention counseling for their high-risk patients.

Prognostic significance of home heart rate in the Japanese HOMED-BP study.

Prognostic significance of home heart rate in the Japanese HOMED-BP study.

A Heart Rate Calculation Method Based on Dynamic Rectangular Window Interception

Aiming at the detection of instantaneous heart rate of heart sounds, a dynamic rectangle window interception calculation method was designed and a heart sound acquisition system was developed. The system can be used to monitor the state of heart at home for adults and foetuses. The algorithm can be used for analysis of adult heart sounds, fetal heart sounds acquired by the acquisition system and ultrasound Doppler heart sound. The algorithm firstly performs a normalization processing on the sound signal and then filters the filter, captures the data in a rectangular frame dynamically, locates the heart sound signal, calculates the instantaneous heart rate, and finally obtains the heart rate with high accuracy. Study shows that the heart rate algorithm has the characteristics of high recognition accuracy and fast calculation speed, which can realize the convenient and rapid home heart rate monitoring for adults and fetuses.

A0623 Effects of empagliflozin on day-to-day variability of home blood pressure and heart rate in patients with type 2 diabetes

Objectives: The effects of empagliflozin in addition to standard care, on day-to-day variability of self-measured home blood pressure (BP) and heart rate (HR) at home in patients with type 2 diabetes (T2DM) at high cardiovascular risk are not known. Methods: We followed twenty-three consecutive T2DM patients (mean age: 69 years old, 12 men, mean BMI: 29.0 kg/m2) with cardiovascular risk to add 10 mg of empagliflozin once daily for three months. Home BP and HR were measured once every morning at home, using an oscillometric device. Results: For home BP, empagliflozin significantly reduced systolic blood pressure (SBP) from 130 ± 11 mmHg at baseline to 126 ± 11 mmHg at the first week (1W) of the administration (P < 0.05). SBP achieved the target home BP goal (125 ± 11 mmHg) at the second week (2W) and was maintained during the study (12W: 124 ± 10 mmHg, P < 0.01). As regards day-to-day variability of SBP, SD mmHg and coefficient of variation (CV) %: SD/mean SBP decreased from 7.3 ± 3.5 mmHg and 5.6 ± 2.7 % at baseline to 6.7 ± 2.5 mmHg and 5.4 ± 1.9 %, respectively, at 1W (8W: 5.2 ± 2.3 mmHg and 4.2 ± 1.9 %, P < 0.05). In diastolic blood pressure (DBP), there was a significant reduction of SD and CV compared with that at baseline (4.9 ± 1.6 mmHg and 6.9 ± 2.3 % at baseline, 8W: 3.9 ± 1.8 mmHg and 5.5 ± 2% P < 0.05); however, there was no change of DPB (71 ± 10 mmHg at baseline). Similarly, there was a decreasing trend in SD and CV of HR (3.9 ± 1.2 beats per minute (bpm) and 6.3 ± 1.9 % at baseline, 4W: 3.3 ± 1.3 bpm and 5.4 ± 2.1 % p < 0.1), although there was no significant change in HR (62 ± 13 bpm at baseline). Conclusion: 1, Empagliflozin significantly reduced systolic home BP, without increasing HR in T2DM patients. 2, Empagliflozin tended to reduce the day-to-day variability of self-measured morning home BP and HR in T2DM patients.

AMBULATORY VERSUS HOME BLOOD PRESSURE

Objective: To identify the blood pressure (BP) measuring method, home, 24 h ABPM and clinic, that can better predict early vascular ageing (EVA) and to create a new predictive model for EVA from BP measurements and other risk factors. Design and method: 282 consecutive subjects (39.7% male) aged 56.8 ± 15.8 years were included in the study. BP was measured at office and out of office with 24h-ABPM on a usual working day and seven days home BP monitoring. Pulse wave velocity (PWV) was measured after 15 min of rest in the supine position. EVA represented carotid-femoral PWV values higher than the expected for age average values. Results: In the univariate analysis, EVA correlated with office systolic BP, average 24 h systolic BP, 24 h diastolic BP, average 24 h and home heart rate, and office heart rate (p < 0.05). The area under the curve for the diagnosis of EVA was 0.620 (90% CI 0.55, 0.69), 0.559 (90% CI 0.48, 0.64) and 0.565 (90% CI 0.49, 0.64), for 24 h, home and clinic systolic BP, respectively. The 24 h systolic and diastolic BP, 24 h heart rate and risk factors such as body mass index, gender, age, creatine clearance, diabetes mellitus, were used to develop a new prediction score with Random Forest algorithm for the prediction of EVA providing a total accuracy 0.82 and high rates of sensitivity and specificity. Conclusions: In conclusion, 24 h systolic BP from ABPM is a better predictor for EVA than home and clinic systolic BP. A new risk assessment tool for EVA was created by 24 h ABPM variables, age, sex, body mass index, diabetes mellitus and creatine clearance.

EFFECTS ON HOME BLOOD PRESSURE AND HEART RATE OF SEQUENTIALLY ADDING DULAGLUTIDE TO THERAPY IN PEOPLE WITH TYPE 2 DIABETES MELLITUS WHO HAD PREVIOUSLY BEEN RECEIVING EMPAGLIFLOZIN

Objective: Glucagon-like peptide-1 (GLP-1) receptor agonists, used to treat type 2 diabetes mellitus, have been reported to be associated with a small reduction in systolic blood pressure (SBP) and increases in heart rate (HR). However, for patients with type 2 diabetes mellitus (T2DM) at high cardiovascular risk who had previously been receiving 10 mg of sodium-glucose cotransporter 2 inhibitor empagliflozin once daily for one year, the effects are not known regarding the effects of once-weekly GLP-1 receptor agonist dulaglutide in addition to therapy on self-measured home blood pressure (BP) and heart rate (HR) at home. Design and method: We followed twelve consecutive T2DM patients (mean age: 68 years old, 4 men, mean BMI: 28.0 kg/m2) with cardiovascular risk after adding 0.75 mg of dulaglutide once weekly, for three months. Home BP and HR were measured once every morning at home, using an oscillometric device. Results: The administration of empagliflozin induced significant (0.7 ± 0.8%) reductions of glycated hemoglobin (HbA1c) and significant (2.8 ± 2.5 kg) reductions of body weight (BW) during the first three months, and dulaglutide also significantly reduced HbA1c and BW from 7.4 ± 0.8% and 68.8 ± 10.2 kg at baseline to 6.3 ± 0.5% and 66.7 ± 11.0 kg at the end of the study, respectively (P < 0.01). For home blood pressure, dulaglutide significantly reduced SBP from 128 ± 10 mmHg at baseline to 124 ± 10 mmHg at the fourth week (4W) of the administration (P < 0.05). SBP achieved the target home blood pressure goal at 4W, and was maintained during the study (8W: 122 ± 10 mmHg, P < 0.01). In the case of empagliflozin, at 1W of the administration it significantly reduced SBP from 130 ± 11 mmHg at baseline to 126 ± 11 mmHg (P < 0.01) (12W: 124 ± 10 mmHg). However, there was no change in diastolic blood pressure (DPB) upon administration of empagliflozin or dulaglutide (DPB: 71 ± 6 mmHg at baseline). Dulaglutide significantly increased HR from 68 ± 10 beats per minute (bpm) at baseline to 72 ± 10 bpm at 8W (P < 0.01), although there was no significant change in HR upon administration of empagliflozin. Conclusions: Dulaglutide significantly and slowly reduced home SBP with increase of HR at home, compared with empagliflozin.

Abstract P368: Effects of Empagliflozin on Day-to-day Variability of Home Blood Pressure and Heart Rate in Patients with Type 2 Diabetes

Background: The effects of empagliflozin in addition to standard care, on day-to-day variability of self-measured home blood pressure (BP) and heart rate (HR) at home in patients with type 2 diabetes (T2DM) at high cardiovascular risk are not known. Method: We followed twenty-three consecutive T2DM patients (mean age: 69 years old, 12 men) to add 10 mg of empagliflozin once daily for three months. Home BP and HR were measured once every morning at home, using an oscillometric device. The variability of BP and HR were defined as the standard deviations (SD) of measurements which were performed on seven consecutive days. Results: For home blood pressure, empagliflozin significantly reduced systolic blood pressure (SBP) from 130±11 mmHg at baseline to 126±11 mmHg at the first week(1W) of the administration (P&lt;0.05). SBP achieved the target home BP goal (125±11 mmHg) at the second week(2W) and was maintained during the study (P&lt;0.01). As regards day-to-day variability of SBP, SD decreased from 7.3±3.5 mmHg at baseline to 6.7±2.5 mmHg at 1W (4W: 6.4±2.8 mmHg, 8W: 5.2±2.3 mmHg, P&lt;0.05). In diastolic blood pressure (DBP), there was a significant reduction of SD compared with that at baseline (4.9±1.6 mmHg at baseline, 4W: 4.3±1.6 mmHg, 8W: 3.9±1.8 mmHg, 12W: 4.4±1.6 mmHg, P&lt;0.05); however, there was no change of DPB (71±10 mmHg at baseline, 12W: 71±8 mmHg). Similarly, there was a decreasing trend in SD of HR (3.9±1.0 beats per minute (bpm) at baseline, 4W: 3.3±1.3 bpm, 12W: 3.1±1.3 bpm, P&lt;0.1), although there was no significant change in HR (62±13 bpm at baseline, 12W: 61 ± 12 bpm). Conclusion: Empagliflozin tended to reduce the day-to-day variability of self-measured morning home BP and HR.

Effects of lercanidipine hydrochloride versus felodipine sustained-release on day-to-day home blood pressure variability

Objective: The objective of this study was to compare the effectiveness of lercanidipine with felodipine in patients with mild-to-moderate hypertension on day-to-day home blood pressure variability.Methods: This is a sub-study of a multicenter, randomized, open-label, parallel group and active controlled clinical trial. Hypertensive patients aged 18–75 (i.e. diastolic blood pressure ≥90 mmHg and <110 mmHg; systolic blood pressure ≥140 mmHg and <180 mmHg) and 24 h mean BP >130/80 mmHg) were eligible for this study. During the study, blood pressure (BP) and heart rate (HR) were recorded. The day-to-day BP variability (BPV) and HR variability (HRV) were obtained by the standard deviation (SD) of daily BP/HR average (of six readings) in 7 days.Results: There were 186 patients (89 and 97 patients in the lercanidipine and felodipine groups, respectively) included in this study. Lercanidipine hydrochloride 10 mg/d and felodipine sustained-release tablets 5 mg/d were given to their respective groups. After 6 weeks of treatment, SD of home BP significantly reduced compared with baseline in both groups (P < .05) while SD of home HR also changed significantly after treatment (P < .05). There was no significant difference in SD of home BPV between the lercanidipine and felodipine groups after treatment.Conclusion: Treatment with lercanidipine and felodipine both resulted in reduction of BPV and HRV. There was no significant inter-group difference in reduction of BPV between the groups. Lercanidipine is an effective antihypertensive drug in improving BPV.National clinical trial: NCT01520285.

Association between N-terminal pro B-type natriuretic peptide and day-to-day blood pressure and heart rate variability in a general population: the Ohasama study.

In addition to day-to-day variability in blood pressure (BP) or heart rate (HR), N-terminal pro B-type natriuretic peptide (NT-proBNP) has been reported to be a predictor of cardiovascular disease. Here, we tested the hypothesis that day-to-day BP or HR variability calculated as the intraindividual standard deviation (SD) of home BP or HR is associated with elevated NT-proBNP in a cross-sectional study. Among 664 participants (mean age, 61.9 years; female, 70.5%) from a general Japanese population without a history of heart disease, 86 (13.0%) had NT-proBNP at least 125 pg/ml. Each 1 SD increase in the SD of home systolic BP (SBP) [odds ratio (OR), 1.82; P < .0001) and in the SD of home HR (OR, 1.44; P = 0.008) were significantly associated with the prevalence of NT-proBNP at least 125 pg/ml after adjustment for possible confounding factors including home SBP and HR. Among the four groups defined by the median SD of home SBP and of home HR, the group with higher SDs in home SBP (≥8.0 mmHg) and HR (≥5.0 bpm) had the greatest OR for the prevalence of NT-proBNP at least 125 pg/ml (OR, 4.80; P = 0007 vs. a reference group with lower SDs of home SBP and HR). These results suggest that day-to-day variability in BP and HR may be associated with target-organ damage or complications, which can lead to an elevated NT-proBNP level. An elevated NT-proBNP level may be involved in the prognostic significance of day-to-day variability in BP or HR.

Beat-to-beat, ambulatory hour-to-hour, and home day-to-day variabilities in blood pressure, pulse pressure, and heart rate in comparison with each other and with target-organ damage.

The objective was to compare beat-to-beat, ambulatory hour-to-hour, and home day-to-day variability in blood pressure (BP), pulse pressure (PP), and heart rate (HR) with each other and with target-organ damage. We studied a population-based sample of Finnish adults including 150 healthy participants aged between 35 and 64 years. Variability in BP and HR was assessed using self-measured morning and evening recordings from seven consecutive days and 24-h ambulatory recordings. Frequency domain measures of beat-to-beat BP variability and baroreflex sensitivity were determined from 5-min time series. The study participants underwent clinical examination, a clinical interview, measurement of urine albumin levels, and echocardiographic examination. Home BP/PP variability parameters and low frequency (LF) power of beat-to-beat BP/PP variability were mainly associated with left ventricular mass index (LVMI) in models adjusted for age, sex, and BP/PP level. The associations of LVMI with PP variability parameters were stronger than the corresponding associations with BP parameters. The associations of PP variability parameters with LVMI were stronger in old than in young individuals. Home BP/PP variability parameters were mainly associated with the LF power of beat-to-beat BP/PP variability in models adjusted for age, sex, and beat-to-beat BP/PP level and the associations were stronger in old than in young individuals. Home HR variability parameters and 24-h hour-to-hour HR variability were mainly associated with LF/high-frequency powers of beat-to-beat HR variability. Reading-to-reading BP/PP variability parameters and their corresponding beat-to-beat variability parameters are partially connected, possibly to common regulatory mechanisms. Their prognostic significance in relation to cardiovascular outcome needs further investigation.

8-OR

Objectives On March 11, 2011, the Great East Japan Earthquake hit northeast Japan. Previous letter on Hypertension by Sato et al reported that 11.6/3.9 mmHg for systolic/diastolic blood pressure (BP) and 4.7 bpm for heart rate (HR) elevations were observed by home BP measurement among hypertensive outpatients aged 68.1 ± 8.8 years. In this study we observed home BP change before and after the earthquake among pregnant women. Methods We used database from the BOSHI study which participated pregnant women from October 2006 to September 2011 at a maternity hospital In Miyagi Prefecture, Japan. The participants were asked to measure their own BPs every morning at home while they were pregnant. A linear mixed model was used for analysis of the BP course throughout pregnancy. Results Total 1137 pregnant woman was included into the analysis. Of those, 210 pregnant women were participated before the earthquake and gave birth after the earthquake. Of those, 133 women measured their BP in March 2011. The average number of home BP measurements was 13.8 in March 2011. Home BP and HR which are not measured in March 2011 were 105.9(105.4–106.4)/63.2(62.8–63.6) mmHg and 74.3(73.9–74.7) bpm, respectively. Home BP and HR were 105.0(103.5–106.4)/64.1(62.8–65.3) mmHg, 73.8(71.8–81.8) bpm in the morning at March 11, 2011 (just before the earthquake), and 110.7(104.8–116.6)/63.6(58.4–68.8) mmHg, 76.3(70.2–82.5) bpm in the morning at March 12, 2011 (just after the earthquake), respectively. Conclusions Home BP was immediately elevated just after the earthquake and gradually decreased over a month as we previously reported among hypertensive patients. Because we only analyzed BP who could keep their equipment, the BP change just after the earthquake might be underestimated. Disclosures H. Metoki: Research Support Recipient; Commercial Interest: Omron Healthcare. N. Iwama: None. Z. Watanabe: None. T. Ohkubo: None. M. Ishikuro: None. T. Obara: None. M. Kikuya: None. J. Sugawara: None. S. Kuriyama: None. K. Itoh: None. K. Hoshi: None. M. Suzuki: None. M. Satoh: None. N. Yaegashi: None. Y. Imai: None.

Hypotensive and Heart Rate-Lowering Effects of Low-Dose Bisoprolol Determined Based on Self-Measured Blood Pressure at Home

We investigated morning home blood pressure (BP)- and heart rate (HR)-lowering effects of 2.5/5 mg bisoprolol in 70 patients with essential hypertension. After 4 weeks of treatment, mean home systolic/diastolic BP and HR significantly decreased by 2.6/5.2 mm Hg and by 8.1 bpm, respectively (all P < .05). The time required to reach 95% of the maximum lowering effect of bisoprolol (stabilizing time) was 5.1 days for home systolic BP (P = .2), 5.1 days for home diastolic BP (P = .0007), and 4.3 days for home HR (P < .0001). We demonstrated that the administration of low-dose bisoprolol significantly and rapidly decreased home BP and HR.

Associations Between Day-by-Day Variability in Blood Pressure Measured at Home and Antihypertensive Drugs: The J-HOME-Morning Study

We identified the factors associated with home blood pressure (BP) variability in 1933 patients treated with hypertensive drugs (mean age, 67 years; women, 55%). Multivariate regression analysis showed that female gender, advanced age, home BP value, and home heart rate variability were positively associated with home BP variability, whereas home heart rate, body mass index, and duration of antihypertensive treatment were negatively associated with home BP variability. Moreover, not being medicated with amlodipine and being medicated with angiotensin II receptor blockers were associated with increased home systolic BP variability only among patients who were treated for less than 12 months.

Response to Prognostic Value of the Home Blood Pressure Variability: Which Is Best?

We appreciate the comments of Matsui and Kario.1 In our article, the main emphasis was to study the prognostic significance of the variability variables in home-measured blood pressure (BP) and home heart rate, by using SD, coefficient of variation, and average real variability.2 Referring to the first comment, we agree with Matsui and Kario1 that it would be of great interest to examine whether the maximum home systolic BP is associated with cardiovascular events and also with the variability variables of home BP. Maximum value of home BP …

Prognostic Value of the Variability in Home-Measured Blood Pressure and Heart Rate

The objective of the study was to assess the prognostic value of variability in home-measured blood pressure (BP) and heart rate (HR) in a general population. We studied a representative sample of the Finnish adult population with 1866 study subjects aged 45-74 years. BP and HR self-measurements were performed on 7 consecutive days. The variabilities of BP and HR were defined as the SDs of morning minus evening, day-by-day, and first minus second measurements. The primary end point was incidence of a cardiovascular event. The secondary end point was total mortality. During a follow-up of 7.8 years, 179 subjects had experienced a cardiovascular event, and 130 subjects had died. In Cox proportional hazard models adjusted for age, sex, BP/HR, and other cardiovascular risk factors, morning-evening home BP variability (systolic/diastolic relative hazard: 1.04/1.10 [95% CI: 1.01-1.07/1.05-1.15] per 1-mm Hg increase in BP variability) and morning day-by-day home BP variability (relative hazard: 1.04/1.10 [95% CI: 1.00-1.07/1.04-1.16] per 1-mm Hg increase in BP variability) were predictive of cardiovascular events. Morning-evening home HR variability (relative hazard: 1.07 [95% CI: 1.02-1.12] per 1-bpm increase in HR variability) and morning day-by-day home HR variability (relative hazard: 1.11 [95% CI: 1.05-1.17] per 1-bpm increase in HR variability) were also independent predictors of cardiovascular events. Greater variabilities of morning home BP and HR are independent predictors of cardiovascular events. Because the variabilities of home BP and HR are easily acquired in conjunction with home BP and HR level, they should be used as the additive information in the assessment of cardiovascular risk.

Variability in home-measured blood pressure and heart rate

Both self-reported sleep disorders and higher variability in home blood pressure (BP) and home heart rate (HR) have been associated with increased cardiovascular mortality. The objective of our study was to assess the associations of the variability in home-measured BP and HR with self-reported insomnia and sleep duration. We studied a representative sample of Finnish adult population with 1908 study participants aged 41-74 years. BP/HR measurements were performed on 7 consecutive days. The variability in home-measured BP/HR was defined as the standard deviation of morning - evening, day-by-day and first - second measurements. Self-reported insomnia and sleep duration questionnaires were used to classify participants with sleep disorders. Results from Finn-home study show that morning - evening, day-by-day (morning and evening) and first - second home BP variability variables were significantly higher in participants with persistent insomnia than in those without insomnia. Morning - evening, day-by-day, morning day-by-day and first - second measurements of home HR variability variables were significantly higher in participants with persistent insomnia than in those without insomnia. Systolic morning - evening, day-by-day and morning day-by-day variables of home BP variability were significantly higher in long sleepers and systolic morning day-by-day, diastolic day-by-day and diastolic first - second measurement of home BP variability variables were higher in short sleepers than in the reference group. Insomnia combined with short sleep duration further increases home BP/HR variability. As self-reported sleep disorders are associated with greater variability in home BP/HR and both have cardiovascular prognostic value, we encourage physicians to evaluate these easily obtainable measurements in clinical practice to help identify patients at risk.