Background and Aims. Heart rate (HR) and hypertension are both important risk factors for adverse cardiovascular (CV) events in patients with established coronary artery disease (CAD). We sought to evaluate whether hypertension can modify the effect of admission HR on adverse CV events in patients with acute coronary syndrome (ACS). Methods. A total of 1056 patients with ACS undergoing percutaneous coronary intervention (PCI) were analyzed. All patients were classified into three groups according to the tertiles of admission HR (T1: ≤66 bpm, n = 369; T2: 67–73 bpm, n = 322; and T3: ≥74 bpm, n = 365). The primary endpoint was defined as major adverse CV events (MACEs), including all-cause death, stroke, myocardial infarction, or unplanned repeat revascularization. The multivariate Cox regression model was performed to evaluate the association of admission HR with MACE stratified by hypertension. Results. During the median follow-up of 30 months, a total of 232 patients developed at least one event. After adjusting for other covariates, elevated admission HR was significantly associated with an increased risk of MACE only in patients with hypertension (when T1 was taken as a reference, the adjusted HR of T2 was 1.143 [95% CI: 0.700–1.864] and that of T3 was 2.062 [95% CI: 1.300–3.270]); however, in patients without hypertension, admission HR was not associated with the risk of MACE (when T1 was taken as a reference, the adjusted HR of T2 was 0.744 [0.406–1.364] and that of T3 was 0.614 [0.342–1.101]) ( for interaction). Conclusions. In patients with ACS undergoing PCI, the association of elevated admission HR with an increased risk of MACE was present in individuals with hypertension but not in those without hypertension. This finding suggests a potential benefit of HR control for ACS patients when they concomitantly have hypertension.

中文翻译：

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存在与不存在高血压对急性冠脉综合征患者入院心率相关心血管风险的影响

背景和目标。心率 (HR) 和高血压都是冠状动脉疾病 (CAD) 患者心血管不良 (CV) 事件的重要危险因素。我们试图评估高血压是否可以改变入院 HR 对急性冠状动脉综合征 (ACS) 患者心血管不良事件的影响。方法。共分析了 1056 名接受经皮冠状动脉介入治疗 (PCI) 的 ACS 患者。根据入院 HR 的三分位数将所有患者分为三组（T1：≤66 bpm，n  = 369；T2：67-73 bpm，n  = 322；T3：≥74 bpm，n = 365)。主要终点定义为主要不良心血管事件（MACE），包括全因死亡、中风、心肌梗死或计划外的重复血运重建。采用多变量 Cox 回归模型评估入院 HR 与按高血压分层的 MACE 的相关性。结果. 在 30 个月的中位随访期间，共有 232 名患者发生了至少一个事件。在调整其他协变量后，仅在高血压患者中，入院 HR 升高与 MACE 风险增加显着相关（当以 T1 作为参考时，T2 的调整后 HR 为 1.143 [95% CI：0.700-1.864]，并且T3 为 2.062 [95% CI: 1.300–3.270])；然而，在没有高血压的患者中，入院 HR 与 MACE 风险无关（以 T1 为参考时，T2 的调整后 HR 为 0.744 [0.406-1.364]，T3 的调整后 HR 为 0.614 [0.342-1.101]） (用于交互）。结论。在接受 PCI 的 ACS 患者中，入院 HR 升高与 MACE 风险增加的关联存在于高血压个体中，但在没有高血压的个体中不存在。这一发现表明，当 ACS 患者同时患有高血压时，HR 控制的潜在益处。