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Heart rate: an independent predictor for hypertension?

Heart rate has been implicated as a risk factor in cardiovascular disease [1,2], and sudden death in middle-aged men [3,4]. Furthermore, elevated heart rate has been shown to be an independent predictor of cardiovascular disease [5]. Previously, there was controversy and inconsistency regarding the association between heart rate and hypertension [6–8]. Some studies could not maintain significance for the heart–hypertension association after adjustment for confounders. Therefore, the HARVEST Study [9] published in this issue of the journal should be considered as a landmark study to provide evidencebased medicine data regarding the question of whether the resting heart rate and heart rate changes during follow-up predict the development of sustained hypertension in individuals screened for stage 1 hypertension [9]. Moreover, this study questions whether ambulatory heart rate may improve the predictive value of clinical heart rate for outcome. The main results reveal that clinical heart rate and heart rate changes during the first 6 months of follow-up were independent predictors of subsequent systolic and diastolic blood pressure, regardless of the initial blood pressure level and other confounders. A persistent high heart rate was an independent predictor of future sustained hypertension, regardless of the initial blood pressure and other confounders. These are very important findings because the study population in the HARVEST Study comprised young individuals at low cardiovascular risk who were screened for stage 1 hypertension. Cardiovascular prevention screening should start at a younger age than has previously been the case, starting at age 40 years or older.