Impact of rate-pressure product variability on new-onset cardiovascular disease and all-cause mortality: A prospective cohort study

Abstract

Background and aim: Considering that using systolic blood pressure or heart rate alone cannot comprehensively reflect cardiac workload, we employed the rate-pressure product (RPP) as a risk marker to assess the risks of cardiovascular diseases (CVDs) and all-cause mortality. Furthermore, given that blood pressure and heart rate fluctuations persist throughout life, therefore this study investigated whether lower levels of RPP variability are associated with lower risks of CVDs and all-cause mortality.

Methods and results: We analyzed data from 49,792 participants in the Kailuan Study, a prospective cohort of Chinese adults who underwent three consecutive health examinations between 2006 and 2010. RPP variability was calculated using systolic blood pressure and heart rate data, and participants were categorized into tertiles, with the highest tertile serving as the reference. Cox proportional hazards models were used to evaluate associations between RPP variability and the risks of CVDs and all-cause mortality, with additional interaction analyses by age, sex, and average RPP level. Compared to the highest tertile, participants in the second and first tertiles exhibited significantly lower risks of CVDs (hazard ratios [HRs]: 0.924 [95 % CIs: 0.856-0.997] and 0.875 [0.806-0.950], respectively; P < 0.01) and all-cause mortality (HRs: 0.882 [0.822-0.947] and 0.821 [0.760-0.866], respectively; P < 0.01). Subgroup analysis revealed a significant interaction with age and average RPP level. Age and average RPP level modified the association between RPP variability and CVDs risk, suggesting greater cardiovascular benefits of stable RPP profiles in younger individuals and those with lower baseline cardiac workload.

Conclusion: Long-term lower RPP variability was independently associated with reduced risks of cardiovascular disease and all-cause mortality, regardless of baseline RPP levels. The association was more pronounced in younger individuals and those with lower average RPP, suggesting potential benefit from targeting RPP variability in early cardiovascular prevention strategies.

Keywords: All-cause mortality; Cardiovascular disease; Cohort study; Rate-pressure product variability.