European Heart Journal Advance Access originally published online on March 29, 2008
European Heart Journal 2008 29(10):1327-1334; doi:10.1093/eurheartj/ehn123
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Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease: findings from the INternational VErapamil-SR/trandolapril STudy (INVEST)
1 Medizinische Klinik, Evangelisches Krankenhaus Bielefeld, Akademisches Lehrkrankenhaus der Universität Münster, Bielefeld, Germany
2 Abbott GmbH & Co. KG, Ludwigshafen, Germany
3 Abbott, Abbott Park, Chicago, IL, USA
4 Division of Cardiovascular Medicine, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100277, Gainesville, FL 32610-0277, USA
Received 29 June 2007; revised 26 February 2008; accepted 29 February 2008; online publish-ahead-of-print 29 March 2008.
* Corresponding author. Tel: +1 352 846 0620, Fax: +1 352 371 0370, Email: pepincj{at}medicine.ufl.edu
See page 1218 for the editorial comment on this article (doi:10.1093/eurheartj/ehn164)
Aim: To determine the relationship between resting heart rate (RHR) and adverse outcomes in coronary artery disease (CAD) patients treated for hypertension with different RHR-lowering strategies.
Methods and results: Time to adverse outcomes (death, non-fatal myocardial infarction, or non-fatal-stroke) and predictive values of baseline and follow-up RHR were assessed in INternational VErapamil-SR/trandolapril STudy (INVEST) patients randomized to either a verapamil-SR (Ve) or atenolol (At)-based strategy. Higher baseline and follow-up RHR were associated with increased adverse outcome risks, with a linear relationship for baseline RHR and J-shaped relationship for follow-up RHR. Although follow-up RHR was independently associated with adverse outcomes, it added less excess risk than baseline conditions such as heart failure and diabetes. The At strategy reduced RHR more than Ve (at 24 months, 69.2 vs. 72.8 beats/min; P < 0.001), yet adverse outcomes were similar [Ve 9.67% (rate 35/1000 patient-years) vs. At 9.88% (rate 36/1000 patient-years, confidence interval 0.90–1.06, P = 0.62)]. For the same RHR, men had a higher risk than women.
Conclusion: Among CAD patients with hypertension, RHR predicts adverse outcomes, and on-treatment RHR is more predictive than baseline RHR. A Ve strategy is less effective than an At strategy for lowering RHR but has a similar effect on adverse outcomes.
Key Words: Coronary artery disease • Atenolol • Resting heart rate • Adverse outcomes • INVEST • Verapamil-SR
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