Home Heart Rate Research Articles

Associated Factors of Home Versus Ambulatory Heart Rate Variability in the General Population: The Ohasama Study

We previously demonstrated that heart rate (HR) variability obtained by daytime ambulatory monitoring and that of daily home measurement associated differently with cardiovascular mortality risk; cardiovascular mortality was linked with decreased daytime ambulatory HR variability and increased day-by-day home HR variability. The aim of this study was to identify factors contributing to each variability, clarifying possible reasons for their different predictive values. We obtained daytime ambulatory HR and home HR in 538 individuals of a general Japanese population aged ≥55 years. Daytime ambulatory HR variability and day-by-day home HR variability were estimated as a standard deviation measured every 30 min by daytime ambulatory monitoring and day-by-day home measurements once in the morning for 4 weeks, respectively. There was only weak correlation between daytime ambulatory HR variability and day-by-day home HR variability (r = 0.08∼0.14). In a multiple regression model, daytime ambulatory HR variability was associated with daytime ambulatory HR (P < 0.0001), daytime ambulatory blood pressure (BP) variability (P < 0.0001), and male sex (P = 0.003), while negatively associated with daytime ambulatory systolic blood pressure (SBP) (P < 0.0001) and smoking (P = 0.038). Meanwhile, day-by-day home HR variability was positively associated with home HR (P < 0.0001), day-by-day home BP variability (P < 0.0001), and male sex (P = 0.018). Associated factors of daytime ambulatory HR variability and day-by-day home HR variability were different. Our findings suggest that HR variabilities by different intervals of measurements might be mediated by different mechanisms.

Evening Heart Rate Measured at Home is Associated With Visceral Obesity and Abnormal Fat Distribution in Patients With Hypertension

Our aim was to examine the association between heart rate (HR) and visceral obesity and abnormal fat distribution in patients undergoing treatment for hypertension. We also ascertained whether such associations differ depending on the time of day when HR is measured and the venue at which the measurement is carried out (office or home). The study enrolled a total of 390 patients (mean age 63.9 years; 45% men) receiving treatment with antihypertensive drugs other than β blockers or nondihydropyridine Ca-channel blockers. Office blood pressure (BP) and HR as well as home BP and HR, both morning and evening, were measured in all these patients for 14 days. The amount of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were determined using abdominal computed tomography (CT). Evening HR was positively associated with VAT (r = 0.26) and negatively associated with SAT (r = -0.16); as a consequence, evening HR was closely associated with the VAT/SAT ratio (r = 0.30; all P < 0.01). In contrast, neither office nor morning HR was associated with VAT. The significant association between evening HR and VAT remained unchanged even after adjustment for significant covariates including SAT (P = 0.001). A multiple logistic regression analysis revealed that a 1-s.d. increase (10 beats per minute) in evening HR was significantly associated with visceral obesity (defined as VAT ≥100 cm)(2) (odds ratio (95% confidence interval: 1.7 (1.3-2.3)), P < 0.001), and that this association was independent of body mass index (BMI) and abdominal obesity (waist circumference ≥85 cm for men and ≥90 cm for women). In these patients receiving treatment for hypertension, high evening HR was associated with visceral obesity, independent of the presence of subcutaneous fat and BMI. This novel finding could explain why cardiovascular risk is higher in individuals with high HR.

Initial Experience With a Multidisciplinary Strategy for Initiation of Propranolol Therapy for Infantile Hemangiomas

To outline a safe, standardized protocol for outpatient initiation of propranolol therapy for infantile hemangiomas. Retrospective review. Academic tertiary care pediatric hospital. Forty-nine infantile hemangioma patients were offered propranolol therapy and included in the study. Any patients requiring hospital admission were excluded. Screening consisted of cardiology evaluation, including electrocardiography and, when indicated, echocardiography. Target initiation dose was 2 to 3 mg/kg/d divided into 3 doses. Blood pressure and heart rate were initially monitored at baseline and 1 and 2 hours in clinic following initial dosing. A 3-hour time point was later added. Families received standardized instructions regarding home heart rate monitoring, side effects, and fasting. Outpatient propranolol therapy was safely initiated in 39 of 44 patients (89%). Five patients required brief admission: 1 with clinical signs/symptoms of heart failure, 3 having airway involvement, and 1 for social reasons. Propranolol administration transiently reduced blood pressure; the maximal decrease occurred at 2 hours, prompting addition of a 3-hour time point to ensure recovery. No patients exhibited symptomatic hypotension, bradycardia, or heart failure. In most children with infantile hemangiomas, propranolol therapy can be safely initiated as an outpatient. Careful cardiovascular evaluation by an experienced clinician is essential for pretreatment evaluation, inpatient admission (when necessary), blood pressure and heart rate monitoring following initial dosing, and parent education. This standardized multidisciplinary outpatient initiation plan reduces the cost of initiating therapy compared with inpatient strategies while still providing appropriate monitoring for potential treatment complications. Further evaluation of propranolol therapy efficacy at the current dosing and duration of treatment continues.

Factors affecting the variability of home-measured blood pressure and heart rate: the Finn-home study

Information of the determinants affecting home blood pressure (BP) and heart rate (HR) variability is very limited. The objective of the study was to assess the determinants of home BP and HR variability in an unselected European population. We studied a sample of 1908 patients aged 41-74 years. Study participants underwent a clinical examination and determination of serum lipids and glucose. Home BP and HR measurements were performed twice in the morning and in the evening during 7 consecutive days (28 measurements). BP and HR variability was defined as the SD of morning minus evening, day-by-day and first minus second measurements. Old age, cardiovascular disease, diabetes and high home BP were independent determinants of greater morning minus evening home BP variability. Old age, excessive use of alcohol and high home BP were independent determinants of greater day-by-day home BP variability, and old age, female sex, cardiovascular disease and high home BP were independent determinants of greater first minus second home BP variability. On the contrary, young age, moderate use of alcohol and high home HR were independent determinants of both greater morning minus evening and day-by-day home HR variability. In addition, young age, female sex and high home HR were independent determinants of first minus second home HR variability. As home BP variability and HR variability have prognostic significance, it is important for the physicians to understand underlying causes of home BP and HR variation. Physicians should focus alcohol, diabetes and cardiovascular disease prevention counseling on their high-risk patients.

Factors Associated With Day-By-Day Variability of Self-Measured Blood Pressure at Home: The Ohasama Study

We previously reported that high day-by-day blood pressure (BP) variability derived from self-measured BP at home (home BP) predicted cardiovascular mortality over and beyond other risk factors. The objective of this study is to clarify the determinants of the day-by-day home-BP variability. We conducted a cross-sectional community survey in 1,215 inhabitants (female gender 59%, mean age 62 years) of Ohasama, Japan. The subjects measured their BP and heart rate once every morning and once every evening for 4 weeks. The day-by-day BP variability and heart rate variability were defined as within individual standard deviation of all home BP and heart rate, respectively. We also considered coefficient of variation (CV). These parameters in the morning and those in the evening were calculated separately. The level and standard deviation of home systolic/diastolic BP (SBP/DBP) in the morning were 123.4 +/- 15.1/75.7 +/- 9.0 mm Hg and 8.6 +/- 3.1/5.8 +/- 2.0 mm Hg. Multivariate linear regression analysis demonstrated that older age, female gender, elevated home BP, low home heart rate, and elevated home heart rate variability were significant determinants of elevated home-BP variability. In addition to these factors, alcohol intake and sedentary lifestyle were also determinants of elevated home-BP variability in the evening. Day-by-day home-BP variability was associated with home BP, alcohol intake or sedentary lifestyle. Whether modifying these factors would reduce BP variability and whether such reduction would lead to better outcomes needs further study.

Office and out of office heart rate measurements: which clinical value?

Office and out of office heart rate measurements: which clinical value?

Incorporating self-blood pressure measurements at home in the guideline from the Ohasama study

Recent guidelines for the treatment of hypertension have all emphasized the importance of self-blood pressure (BP) measurements at home (home BP) in clinical applications of practice, research, and epidemiology. In the Ohasama study, a cohort study based on home BP, we have demonstrated several important findings to be incorporated in those guidelines. We demonstrated that home BP more accurately and reliably reflect target organ damage and the prognosis of cardiovascular disease than conventional BP, whereas the predictive value of home BP increased progressively with the number of measurements. Even the initial-first home BP values (one measurement) showed a significantly greater relation with stroke risk than conventional BP values (mean of two measurements). Home BP in the morning (morning BP) and in the evening (evening BP) provide equally useful information for stroke risk, whereas morning hypertension, which is that specifically observed only in the morning, might be a good predicator of stroke, particularly among individuals using anti-hypertensive medication. Home BP increased the predictive power of categorizations of guidelines compared with conventional BP. Heart rate values assessed at home using a device designed for home BP measurement (home heart rate) was significantly associated with the risk of cardiovascular mortality, independent of home BP. We expect that continuous follow-up and further analysis of the Ohasama data would contribute to producing further important findings worth incorporating in future hypertension guidelines.

Control of home heart rate and home blood pressure levels in treated patients with hypertension: the J-HOME study

Recently, it was found that resting heart rate (HR) measured at home (home HR), as well as self-measured blood pressure (BP) at home (home BP), was a strong predictor of the risk of cardiovascular disease mortality in the general Japanese population. It was also reported that home BP levels were not adequately controlled in hypertensive patients. Little information, however, is available on the current status of home HR control in treated patients with hypertension. The objective of this study was to examine the current status of home HR control and home BP control among treated patients with hypertension. Home HR and BP were measured using a self-monitored BP measuring device. Morning home HR and BP were obtained in 3183 patients and evening home HR and BP were obtained in 3106 patients. On the basis of an earlier study, we defined a home HR value of >or=70 beats/min as 'high home HR'. The mean home HR value was 67.2+/-9.1 beats/min in the morning and 69.6+/-9.2 beats/min in the evening. Of the 3183 patients, 35.7% had a high home HR in the morning and 46.7% of the 3106 patients had a high home HR in the evening. The prevalence of patients with a high home HR and a controlled home BP (<135/85 mmHg) was 11.3% in the morning and 24.2% in the evening. Resting home HR control and home BP control were inadequate.

Determinación del límite de normalidad de la presión arterial mediante la automedida domiciliaria

Home blood pressure (HBP) is frequently used in clinical evaluation; however the interpretation of the data collected is lacked of a precide definition of normal HBP, so we did this study. A random sample of 1,136 was selected, stratified by gender and age (25 up to 64 years old). Those receiving antihypertensive therapy were excluded. Clinical blood pressure (CBP) consisted of three measurements, with the mercury sphygmomanometer (MS) and with the automatic blood pressure device (Omron 705 CP) (AD). Heart rate (HR), body weight and height were registered. HBP: each participant was asked to obtain 9 home measurements, three in the morning (M), three in the afternoon (A) and three at night (N). Statistical methods included Student's t test for paired comparisons, ANOVA and regression analysis. CBP and HBP measurements (mmHg) were obtained in 734 participants. The means of S-CBP/D-CBP with the MS were 123.5 +/- 15.1/ 76.4 +/- 10.4 and 122.4 +/- 14.4/75.6 +/- 10.0 and with the AD, 123.4 +/- 16.1/73.7 +/- 10.4. The average of S-HBP/D-HBP in the total sample was 115.0 +/- 14.3/69.2 +/- 9.0. The HBP measurements were significantly lower than CBP (p < 0.05). The mean of clinic HR was 70.3 +/- 10.4. The average of home HR in the whole sample was 67.9 +/- 9.7. The clinic HR and the home HR were significantly different (p < 0.05). The upper limit of normality for HBP obtained from the values that correspond on the mean +2 SD to the CBP value of 140/90 was 135/82. The 95th percentile value of the HBP in the whole sample was 131/80. The upper limit of normality for HBP obtained from the values that correspond on the regression lines in the group with CBP < 140/90 was 125/78, in the group with CBP >or= 140/90 was 130/81 and in the total sample was 128/81. We consider that the upper limit of normality of home blood pressure is 130/81. Clinic heart rate is higher than home heart rate, which demonstrates a phenomenon of alerting reaction.

Factors Affecting Home-Measured Resting Heart Rate in the General Population: The Ohasama Study

We recently demonstrated that a home-measured resting heart rate (HR) can predict cardiovascular disease mortality, and it is possible that the determinants of home HR are different from casual HR. Therefore, clarifying the determinants of home HR should be useful. Home HR was obtained using a self-monitored blood pressure (BP) measuring device. The impact of factors including home-measured BP and lifestyle on home HR was examined in 1275 members of the general Japanese population aged > or =40 years. Multivariate linear regression analysis demonstrated that younger age (beta = -0.08, P < or = .01), current smoking (beta = 3.22, P < or = .01), female gender (beta = 2.07, P < or = .01), and sedentary lifestyle (walking for < or =1 h/day) (beta = 2.43, P < or = .01) were determinants of elevated morning home HR. No significant association was observed between home HR and home systolic BP, whereas casual HR was significantly and positively associated with casual systolic BP. The difference between casual and home HR was also significantly and positively associated with the difference between casual and home systolic BP, suggesting that positive association between BP and HR obtained in clinic settings would be a reflection of the so-called white-coat effect. We observed that, with the exception of BP, most determinants of home HR were consistent with the determinants observed in previous studies using casual HR. These results suggest that reduction of home HR through modification of smoking habit or sedentary lifestyle may have a potential to decrease cardiovascular risk in addition to decreasing in these modifiable risk factor per se.

Prognostic value of home heart rate for cardiovascular mortality in the general population: The Ohasama study

Recently, the advantages of self-measurement of blood pressure (BP) at home have been recognized. The same advantages could also be applicable to resting heart rate (HR) values assessed at home using a device designed for home BP measurement. However, there have been no studies investigating whether home HR values predict the risk of cardiovascular disease mortality. We therefore investigated the usefulness of HR values in predicting cardiovascular mortality using a device that allowed self-measurement of BP and HR at home. The association between the home-measured resting HR and the 10-year risk of cardiovascular mortality was examined in 1780 Japanese individuals >/=40 years of age who had no significant arrhythmias. A Cox proportional hazards model that adjusted for major risk factors was used. An increase of 5 beats/min in the morning home HR measurement was associated with a 17% increase in the risk of cardiovascular mortality (95% confidence interval 5% to 30%). This relationship was also statistically significant after adjustment for home BP values. Even when home-measured systolic BP was within the normal range (<135 mm Hg), subjects with HR >/=70 beats/min had a higher risk of cardiovascular mortality (relative hazard 2.16, 95% confidence interval 1.21 to 3.85) than those with normal systolic BP and HR values. Self-measurement of HR at home, together with self-measurement of BP, is a simple method of providing useful clinical information for assessing cardiovascular risk.

Prognostic value of home heart rate for cardiovascular mortality in the general populationThe Ohasama study

Prognostic value of home heart rate for cardiovascular mortality in the general populationThe Ohasama study

Increased Plasma 8-Isoprostane Levels in Hypertensive Subjects: the Tsurugaya Project

To examine the relationship between 8-isoprostane and blood pressure, we measured plasma 8-isoprostane concentration and home blood pressure levels in an elderly Japanese population. Our study population comprised 569 subjects aged 70 years and over who were not receiving antihypertensive medication. On the basis of their blood pressure values, the participants were classified into three groups: normotensive (home blood pressure <135/85 mmHg), hypertensive (home blood pressure 135/85-160/90 mmHg), and severely hypertensive (home blood pressure > or =160/90 mmHg). The mean plasma 8-isoprostane level in the severely hypertensive group (21.1+/-5.2 pg/ml) was significantly higher than that in the normotensive (20.2+/-4.9 pg/ml) or hypertensive (19.7+/-5.1 pg/ml) group, and this result was unchanged when we adjusted for possible confounding factors such as age, sex, use of vitamin A, C or E supplements, smoking status, drinking status, body mass index, use of non-steroidal anti-inflammatory drugs, history of diabetes, hypercholesterolemia, home heart rate and serum creatinine level. Thus, the level of plasma 8-isoprostane appears to be elevated in older subjects with severe hypertension.