Association of resting heart rate with cardiovascular function: a cross-sectional study in 522 Finnish subjects

Jenni K Koskela, Anna Tahvanainen, Antti Haring, Antti J Tikkakoski, Erkki Ilveskoski, Jani Viitala, Miia H Leskinen, Terho Lehtimäki, Mika Ap Kähönen, Tiit Kööbi, Onni Niemelä, Jukka T Mustonen, Ilkka H Pörsti, Jenni K Koskela, Anna Tahvanainen, Antti Haring, Antti J Tikkakoski, Erkki Ilveskoski, Jani Viitala, Miia H Leskinen, Terho Lehtimäki, Mika Ap Kähönen, Tiit Kööbi, Onni Niemelä, Jukka T Mustonen, Ilkka H Pörsti

Abstract

Background: High resting heart rate (HR) is associated with increased cardiovascular risk in general populations, possibly due to elevated blood pressure (BP) or sympathetic over-activity. We studied the association of resting HR with cardiovascular function, and examined whether the hemodynamics remained similar during passive head-up tilt.

Methods: Hemodynamics were recorded using whole-body impedance cardiography and continuous radial pulse wave analysis in 522 subjects (age 20-72 years, 261 males) without medication influencing HR or BP, or diagnosed diabetes, coronary artery, renal, peripheral arterial, or cerebrovascular disease. Correlations were calculated, and results analysed according to resting HR tertiles.

Results: Higher resting HR was associated with elevated systolic and diastolic BP, lower stroke volume but higher cardiac output and work, and lower systemic vascular resistance, both supine and upright (p < 0.05 for all). Subjects with higher HR also showed lower supine and upright aortic pulse pressure and augmentation index, and increased resting pulse wave velocity (p < 0.001). Upright stroke volume decreased less in subjects with highest resting HR (p < 0.05), and cardiac output decreased less in subjects with lowest resting HR (p < 0.009), but clear hemodynamic differences between the tertiles persisted both supine and upright.

Conclusions: Supine and upright hemodynamic profile associated with higher resting HR is characterized by higher cardiac output and lower systemic vascular resistance. Higher resting HR was associated with reduced central wave reflection, in spite of elevated BP and arterial stiffness. The increased cardiac workload, higher BP and arterial stiffness, may explain why higher HR is associated with less favourable prognosis in populations.

Trial registration: ClinicalTrials.gov NCT01742702.

Figures

Figure 1
Figure 1
Radial blood pressures during rest and passive head-up tilt according to resting heart rate tertiles. (A) Systolic blood pressure, (B) diastolic blood pressure; mean (95% confidence intervals), p values denote significant differences between the tertiles depicted with different symbols.
Figure 2
Figure 2
Principal hemodynamic variables during rest and passive head-up tilt according to resting heart rate tertiles. (A) Heart rate, (B) stroke index, (C) cardiac index, (D) left cardiac work index, (E) systemic vascular resistance index; mean (95% confidence intervals).
Figure 3
Figure 3
Central pulse pressure and wave reflection during rest and passive head-up tilt according to resting heart rate tertiles. (A) Aortic pulse pressure, (B) augmentation index; mean (95% confidence intervals).
Figure 4
Figure 4
Pulse wave velocity according to resting heart rate tertiles; mean (95% confidence intervals), *p < 0.001 vs. tertile 1.
Figure 5
Figure 5
Evaluation of stroke volume in 16 subjects during passive head-up tilt using echocardiography (Echo) and impedance cardiography (ICG). (A) Comparison of stroke volume measurements mean (95% confidence intervals). (B) Scatterplot depicting the measurements in each individual.

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