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Relationship of Blood Pressure to Heart Rate in Isolated Systolic Hypertension
  1. Jeffrey J. Goldberger, MD,
  2. Jason T. Jacobson, MD
  1. From the Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
  1. Received April 29, 2011, and in revised form July 26, 2011.
  2. Accepted for publication July 27, 2011.
  3. Reprints: Jeffrey J. Goldberger, MD, Northwestern Memorial Hospital, 201 E Huron St, Feinberg 8-503, Chicago, IL 60611. E-mail: j-goldberger{at}northwestern.edu.
  4. The authors have no conflicts of interest to declare.

Abstract

Background Patients with isolated systolic hypertension (ISH) have been noted to be less responsive to β-blockers than patients with essential hypertension (HTN). The purpose of this study was to determine the relationship between blood pressure (BP) and heart rate in ISH.

Methods A total of 619 patients underwent 24-hour ambulatory BP monitoring. Patients were grouped as normal, HTN, or ISH. Clinical characteristics, mean BPs, and mean heart rate were compared between the groups.

Results Two hundred seventy-one patients had normal BP, 98 had HTN, and 90 had ISH. Antihypertensives were used in 37% with normal BP, 51% with HTN, and 58% with ISH. The pulse pressure was highest for ISH (67 [10] mm Hg), followed by HTN (59 [12] mm Hg) and normal BP (49 [7] mm Hg; P < 0.0001). Heart rate in ISH was 71 [10] beats per minute; slower than that for normal BP (73 [11] beats per minute; P = 0.0464) and HTN (78 [12] beats per minute; P < 0.0001).

There was a positive relationship between diastolic BP and heart rate. In ISH, there was a negative relationship between systolic BP and heart rate (slope = −0.18; r = 0.24; P = 0.0209) and a positive relationship between diastolic BP and heart rate (slope = 0.19; r = 0.33; P = 0.0015).

Conclusions The noted relationship of heart rate to systolic BP and pulse pressure may in part explain the lower efficacy of β-blockers in patients with ISH. The rate-lowering effects of these medications may result in an increase in systolic and pulse pressures.

Key Words
  • hemodynamics
  • bradycardia
  • systolic hypertension

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