Determinants of self-measured pulse rate profile in medicated hypertensives: The Jichi morning surge-1 (JMS-1) study

Background. Recently, it was reported that high pulse rate (PR), which was measured using by self-measured blood pressure (BP) monitoring at home, was associated with cardiovascular risk. However, the predictor of high PR at home in treated hypertensives is unknown. In this study, we studied the predictor of high PR and evaluated pulse rate variability (PRV). Methods. In the JMS-1 study, 611 hypertensive outpatients were recruited. Self-measured BP monitoring was conducted consecutively twice in the morning and evening for three days. PR analysis was conducted using the average of these two measurements for three days (six readings in total). We defined home PR as the mean of these six readings. Home PRV was defined as the standard deviation of these six readings. Results. Multivariate linear regression analysis demonstrated that current smoking (β = 0.12, p = 0.002), diabetes (β = 0.16, p < 0.001), lack of angiotensin-converting enzyme (ACE) inhibitor use (β = 0.10, p = 0.008), decreased brain-type natriuretic peptide (BNP; β = 0.17, p < 0.001), and elevated home diastolic blood pressure (β = 0.14, p = 0.009) were determinants of high PR. Determinants of decreased home PRV were female gender (β = 0.10, p < 0.03) and increased hemoglobin A1c (HbA1c; β = 0.15, p < 0.001). When we divided the patients into four groups according to home PR and its variability, hypertensives whose home PR was high and variability was low were found to have high HbA1c (ANOVA, p > 0.05). Conclusions. Smoking habit, diabetes, lack of ACE inhibitor use, and low BNP value were determinants of home PR, and female gender and higher HbA1c were significantly associated with its low variability. Home PR and its variability may be useful for detecting high-risk hypertensive patients, particularly with autonomic neuropathy.