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(Hypertension. 2003;42:1106.)
© 2003 American Heart Association, Inc.

Scientific Contributions

Hypertension, Blood Pressure, and Heart Rate Variability

The Atherosclerosis Risk in Communities (ARIC) Study

Emily B. Schroeder; Duanping Liao; Lloyd E. Chambless; Ronald J. Prineas; Gregory W. Evans; Gerardo Heiss

From the Departments of Epidemiology (E.B.S., G.H.) and Biostatistics (L.E.C.), School of Public Health, University of North Carolina, Chapel Hill; the Department of Health Evaluation Sciences (D.L.), Pennsylvania State University College of Medicine, Hershey, Pa; and the Department of Public Health Sciences (R.J.W., G.W.E.), Wake Forest University School of Medicine, Winston-Salem, NC.

Correspondence to Gerardo Heiss, Department of Epidemiology, University of North Carolina, 137 E Franklin St, Ste 306, Chapel Hill, NC 27514. E-mail gerardo-heiss{at}unc.edu

Dysregulation of the autonomic nervous system has been implicated in the development of hypertension. Heart rate variability is a noninvasive tool to quantitatively estimate cardiac autonomic activity and has been used to document decreased cardiac autonomic activity in hypertension. The ability of decreased heart rate variability to predict incident hypertension has not been well studied, and there are no studies of whether hypertension leads to changes in heart rate variability. We investigated the temporal sequence linking hypertension, blood pressure, and heart rate variability in a population-based cohort of 11 061 individuals aged 45 to 54 years at baseline. Individuals with hypertension had decreased heart rate variability at baseline, and this association was present across the full blood pressure range. Among 7099 individuals without hypertension at baseline, low heart rate variability predicted greater risk of incident hypertension over 9 years of follow-up. The hazard ratio (95% confidence interval [CI]) for the lowest compared with the highest quartile of the standard deviation of normal-to-normal R-R intervals was 1.24 (95% CI, 1.10–1.40), for the root mean square of successive differences in normal-to-normal R-R intervals was 1.36 (95% CI, 1.21–1.54), and for R-R interval was 1.44 (95% CI, 1.27–1.63). Over 9 years, there was no measurable difference in the rate of change in heart rate variability among those with and without hypertension, although the differences in heart rate variability at follow-up were smaller than those at baseline. These findings thus support the thesis that the autonomic nervous system is involved in the development of hypertension, yet suggest that differences in the autonomic profile of hypertensives and normotensives do not increase with time.

Key Words: autonomic nervous system • heart rate • heart rate variability • hypertension, detection and control • blood pressure

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