EVAluation of the prognostic value of BARoreflex sensitivity in hypertensive patients: the EVABAR study

Aims The prognostic value of baroreflex sensitivity in hypertensive patients has not much been studied. Method A cohort of 451 hypertensive patients without cardiovascular history was studied for an average of 6.2 ± 2.8 years follow-up. Each patient had a baroreflex sensitivity measurement by the sequence method, which is represented by the slope of up-sequences (systolic blood pressure+/pulse interval+) and down-sequences (systolic blood pressure−/pulse interval−) of spontaneous fluctuations in systolic blood pressure and pulse interval. Results During the follow-up, there were 20 deaths from any cause and 30 patients presented a major adverse cardiovascular event. Deaths and major adverse cardiovascular events were associated with a reduction in baroreflex sensitivity (systolic blood pressure+/pulse interval+ and systolic blood pressure−/pulse interval−). In multivariate analysis, the reduction in baroreflex sensitivity systolic blood pressure+/pulse interval+ was associated with an increased risk of deaths from any cause (Odds ratio 1.23; 95% confidence interval 1.02–1.67, P = 0.04). A baroreflex sensitivity systolic blood pressure+/pulse interval+ under 4.5 ms/mmHg was associated with a 2.5-increased relative risk of major adverse cardiovascular event (95% confidence interval 1.11–5.93, P = 0.03). However, multivariate analysis showed that baroreflex sensitivity systolic blood pressure−/pulse interval− was not associated either with death or major adverse cardiovascular events. Conclusions Reduction in baroreflex sensitivity marked by a reduction in vagal reflexes is an independent marker of the risk of mortality and major adverse cardiovascular events in hypertensive patients.

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