Dose-response association of resting heart rate and hypertension in adults: A systematic review and meta-analysis of cohort studies

BACKGROUND: The association of resting heart rate (RHR) and hypertension in adults is unclear. We aimed to perform a meta-analysis of cohort studies to clarify the association. METHODS: We searched PubMed and Embase from their inception to November 3, 2017, for published articles. We used a random effects model to combine study-specific relative risks (RRs) and 95% confidence intervals (CIs). We used restricted cubic spline functions to assess the dose-response relationship. RESULTS: Nine cohort articles (12 independent studies) with 79,399 individuals and more than 26,380 incident cases of hypertension were included. The summary RR for hypertension was 1.09 (95% CI: 1.06–1.13) with each 10 bpm increment in RHR. The cubic spline model suggested that when compared with 55.5 beats per minute, the risk of hypertension significantly increased with increasing levels of RHR (P(nonlinearity) = 0.059). CONCLUSION: We found a linear dose-response association between RHR and incident hypertension in adults.