The effects of heart rate, adherence to antihypertensive pharmacotherapy and physical exercise on clinical course of first grade hypertension

Objective. To analyze the prognostic effects of metabolic and hemodynamic characteristics and adherence to treatment in patients with first grade arterial hypertension (HTN). Design and methods. We have examined twice (with interval 71,3 ± 10,5 months) 67 patients with first grade HTN. Baseline and final investigations included office blood pressure (BP) measurements, heart rate and body mass index calculation, ambulatory BP monitoring. In addition, at baseline we assessed the levels of total cholesterol, low and high density lipoproteins, triglycerides. vascular endothelial growth factor, glucose and insulin. We also performed glucose tolerance test. At follow-up, life style changes and adherence to treatment were assessed via structured questionnaires. Eleven patients with adverse outcomes composed a separate subgroup including 5 with HTN worsening, 2 with angina pectoris worsening, 3 with myocardial infarction, 1 case of sudden death. Results. Insulin levels at glucose tolerance test was higher in patients with adverse outcomes. At baseline, fasting and postprandial heart rate was greater than 80 bpm in 91 % of patients with first grade HTN who developed adverse outcomes and in 21 % in the rest of the group (p < 0,001). Disease progression and complication development were registered only in patients with both high/very high cardiovascular risk and heart rate greater than 80 bpm. Only in patients with very high cardiovascular risk major cardiovascular events were detected. Low adherence to treatment significantly worsened prognosis: the majority (80 %) of patients with adverse outcomes took antihypertensive drugs irregularly; 60 % patients with adverse outcomes reduced level of physical activity. Increment in regular physical activity was found more frequently in patients with serum vascular endothelial growth factor > 200 pg/ml. Conclusions. Heart rate greater than 80 bpm is associated with unfavorable prognostic effect in patients with first grade HTN and high/very high total cardiovascular risk. Disease progression and complication development are more frequent in patients with irregular therapy and/or those who reduced physical activity level.

hypertension, prognosis, heart rate, treatment adherence, hyperinsulinemia, vascular endothelial growth factor

1. Boytsov SA, Balanova YuA, Shalnova SA, Deev AD, Artamonova GV, Gatagonova TM et al. Arterial hypertension among individuals of 25–64 years old: prevalence, awareness, treatment and control. By the data from ECCD. Cardiovascular Therapy and Prevention. 2014;14(4):4–14. doi: 10.15829/1728-8800-2014-4-4-14. In Russian.

2. Erina AM, Rotar OP, Orlov AV, Solntsev VN, Shalnova SA, Deev AD et al. Prehypertension and cardiometabolic risk factors (by the data from ECCD-RF). Arterial’naya Gipertenziya = Arterial Hypertension. 2017;57(3):31–38. doi:10.18705/1607-419X-2017-23-3-243-252. In Russian.

3. Mancia G, Fagard R, Narciewich K, Redon J, Zanchietti A, Bohm M et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J. Hypertens. 2013;31 (7):1281–1357.

4. Chasova IE, Oshchepkova EV, Zhernakova YuV, Karpov YuA, Arkhipov MV, Barbarash OL et al. Diagnostics and treatment of arterial hypertension (Clinical recommendations). Kardiologicheskiy Vestnik = Cardiological Bulletin. 2015;10(1):3–10. In Russian.

5. Chobanian AV, Bakris JL, Black HR, Cushman WC, Green LA, Izzo JL et al. The seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure. J Am Med Assoc. 2003;289(19):1206–1252.

6. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ ACPM/ AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):12691324.

7. Ferrini M. The new European Hypertension guidelines: an evolution if not a revolution [Internet]. Council for cardiology practice. 2018. [cited 04.08.2018]. [Electronic resource]. URL: https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/News.

8. Shchukin IuV, Diachkov VA, Surkova EA, Medvedeva EA, Rubanenko AO. Functional diagnostics in cardiology. M.: GEOTAR-Media, 324 p. In Russian.

9. Kobalava ZhD, Kotovskaya YuV, Moiseev VS. Arterial hypertension the key to diagnosis and treatment. M.: GEOTAR-Media, 2009. 867 p. In Russian.

10. Metabolic syndrome. Ed. Roitberg GE. M.: MEDpressinform, 2007. 223 p. In Russian.

11. Reaven GM. Role of insulin resistance in human disease. Diabetes. 1988;37(12):1595–1607.

12. Polonetskiy LZ. Heart rate importance in clinical practice. New capabilities of antianginal therapy. Medical news. 2007;5:7–10. In Russian.

13. Sivakov VP. Heart rate and heart rate variability in arterial hypertension: modern views about research methods, clinical and prognostic significances. VSMU Bulletin. 2010;1:2–12. In Russian.

14. Palatini P, Rosei EA, Casiglia E, Chalmers J, Ferrari R, Grassi G et al. Management of hypertensive patient with elevated heart rate: Statement of the Second Consensus Conference endorsed by the European Society of Hypertension. J Hypertens. 2016; 34 (5):813–821. doi:10.1097/HJH.0000000000000865

15. Williams B, Mancia G, Spiering W, Rosei EA, Burnei M et al. 2018 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(33):3021–3104. doi:10.1093/eurheartj/ehy339

16. Orlov AV, Rotar OP, Boyarinova MA, Demchenko EA, Konradi AO. Physical activity history and development of methodology and guidelines. Arterial’naya Gipertenziya = Arterial Hypertension. 2016;22(2):153–159. doi:10.18705/1607-419X-2016-22-2-153-159. In Russian.

17. Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension. 2005;46(4):667–765.

18. Egginton S. Invited review: activity-induced angiogenesis. Phlugers. Arch. 2009;457(5):963–977. doi:10.1007/s00424-0080563-9

19. Neves VJ, Fernandes T, Rogue FR, Soci UP, Melo SF, de Oliveira EM. Exercise training in hypertension: role of microRNAs. World J Cardiol. 2014;6(8):713–727. doi:10.4330/wjc.v6.i8.713

20. Bailey JE, Wan JY, Tang J, Ghani MA, Cushman WC. Antihypertensive medication adherence, ambulatory visits, and risk of stroke and death. J Gen Intern Med. 2010;25(6):495–503. doi:10.1007/s11606-009-1240-1

21. Kalinina AM, Oganov RG, Nebieridze DV on behalf of the Working Group. Patients’ education as a factor for arterial hypertension effective control — NOCTURNE Program. Cardiovascular Therapy and Prevention. 2006;5(3):5–14. In Russian.

22. Skibitskiy VV, Fendrikova AV. Efficiency of disperse form of perindopril in patients with arterial hypertension in clinical practice. Kardiologiia. 2016;2:19–23. doi:10.18565/cardio.2016.2.19–23. In Russian.

23. Piepoli MF, Hoes AW, Agewall S, Albus Ch, Brotons C, Catapano MT et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37 (29):2315–2381. doi:10.1093/eurheartj/ehw106

24. Viera AJ, Hawes EM. Management of mild hypertension in adults [Internet]. Br Med J. 2016;355: i5719. doi:10.1136/bmj.i5719