Hypertensive cardiac remodeling exhibits significant heterogeneity across distinct joint systolic blood pressure, diastolic blood pressure, and heart rate trajectories, with stable BP control associated with a potential attenuation of early cardiac remodeling even in the presence of an elevated heart rate.
Group-based multitrajectory modeling identified four distinct joint trajectory groups of 24-hour mean systolic blood pressure, diastolic blood pressure, and heart rate in hypertensive patients.
Compared with group 4 (stage 2 hypertension range, high HR), group 2 (normal BP, high HR) showed a significant inverse association with changes in relative wall thickness (ΔRWT).
Antidiabetic medication use was significantly associated with a reduction in relative change in relative wall thickness (ΔRWT).
Waking up before 7 AM was positively associated with an increase in relative change in relative wall thickness (ΔRWT).
Hypertensive cardiac remodeling exhibits significant heterogeneity across distinct joint systolic blood pressure, diastolic blood pressure, and heart rate trajectories.
This research suggests that patients with high blood pressure do not follow a single uniform pattern of blood pressure and heart rate changes over time. By tracking 213 hypertensive patients over roughly six months using wearable blood pressure monitors and heart ultrasounds, researchers identified four distinct groups based on how their blood pressure and heart rate moved together. These groups ranged from those with low blood pressure and heart rate, to those with high blood pressure and high heart rate, with two intermediate groups in between. One important finding is that patients whose blood pressure was well-controlled—even if their heart rate remained elevated—showed less thickening of the heart wall compared to those with both high blood pressure and high heart rate. Heart wall thickening (measured as relative wall thickness) is an early sign of the heart adapting, sometimes harmfully, to the strain of high blood pressure. This research suggests that controlling blood pressure may help slow this early form of heart remodeling, even when heart rate stays high, though this finding became only borderline statistically significant when the analysis was restricted to patients with complete data. Additionally, the use of antidiabetic medications and waking up later in the morning (after 7 AM) were both associated with less heart wall thickening, pointing to potential roles of metabolic treatment and sleep/wake timing in cardiac health among hypertensive individuals. These findings matter because they highlight that not all hypertensive patients experience cardiac changes in the same way, and that the combination of blood pressure and heart rate patterns together—rather than either alone—may better predict early heart remodeling. This research suggests that personalized monitoring approaches, and attention to factors like medication use and morning wake time, could be relevant to understanding and potentially managing early heart changes in people with hypertension.
Pan Q, Zhang N, Yang S, Ding C, Yin J, Fei Y, et al.. (2026). Group-Based Multitrajectory Modeling Analysis of Joint Trajectories of Blood Pressure and Heart Rate and Their Association With Relative Change in Relative Wall Thickness in Patients With Hypertension: Community-Based Longitudinal Cohort Study.. JMIR cardio. https://doi.org/10.2196/87091