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Effect of resting heart rate on the risk of all-cause death in Chinese patients with hypertension: analysis of the Kailuan follow-up study
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  • Published on:
    Multifaceted Interaction Between Heart Rate, Blood Pressure, Comorbidities, and Sex

    Dear Authors and Editorial Team,

    The inverse association between resting heart rate (RHR) and longevity has been the subject of many studies, both in humans and across species [1]. The article by Zhao et al., titled, “Effect of resting heart rate on the risk of all-cause death in Chinese patients with hypertension: analysis of the Kailuan follow-up study” determines that resting heart rate > 76 beats-per-minute (bpm) is a predictor of mortality in Chinese hypertensive patients as well [2]. I applaud the authors for thoroughly adjusting for confounding factors and offering explanations for the association, but would like to bring to discussion key points that may help contextualize the findings.

    Firstly, several studies have established that women have higher RHR than men and tend to have weaker associations between RHR and mortality [3]. Thus, it may be important to develop sex-specific quintiles when categorizing heart rate as women paradoxically also have higher life expectancy than men. Fortunately, this study has a large proportion of men which reduces misclassification bias but may also in turn reduce generalizability of the results to women.

    There are peculiarities among the baseline characteristics by quintile of RHR that may warrant further attention. There seems to be markedly unequal sample sizes across the quintiles (e.g. Q2 = 7589 vs. Q1=10349), suggesting that there may be room to adjust the categories. Furthermore, there is a distinct...

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    Conflict of Interest:
    None declared.