Reviewer COMMENTARY
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Office and Out-of-Office Heart Rate and the
Development of Metabolic Disorders
Taku Obara1,2, Takayoshi Ohkubo3,4 and Yutaka Imai1,4
O
besity, insulin resistance, and diabetes mellitus
may be associated with sympathetic nervous
system activity.1 Heart rate may be considered to
be an expression of sympathetic nervous system
activity.1,2 A previous study demonstrated that
there was a positive relationship between resting heart rate and
the presence of obesity, insulin resistance, and diabetes mellitus.2
However, whether resting heart rate has the power to predict the
development of obesity, insulin resistance, and diabetes mellitus
has not been studied.
In this issue of the Journal, Shigetoh et al. reconfirmed the
existence of a cross-sectional relationship between higher
heart rate obtained by electrocardiogram and a cluster of
­cardio-metabolic factors, including fasting plasma glucose and
HOMA index, and they also demonstrated that higher heart
rate (≥80 bpm) predicted the development of obesity, insulin
resistance, and diabetes mellitus 20 years later in the general
population.3 Several studies reported the relationship between
elevated heart rate and prognosis.2,4,5 It has been demonstrated that resting heart rate measured in the clinical setting
was predictive of cardiovascular mortality in a large number
of studies.2 Heart rate measured at home also predicted cardiovascular mortality in the general Japanese population.4
Conversely, the level and diurnal variation of the ambulatory
heart rate did not predict cardiovascular mortality; it only predicted non-­cardiovascular mortality.2,5 Although the reason for
this discrepancy was unclear, heart rate measured in the clinical
setting, self-measured home heart rate, and heart rate obtained
by ambulatory monitoring may represent different conditions
of sympathetic nervous system activity. Although it should be
pointed out that heart rate was measured by echocardiogram in
the study by Shigetoh et al., they emphasized the value of heart
rate measurement in the clinical setting for assessing the cardiovascular risk profile. In particular, an elevated resting heart
rate in the clinical setting might represent an alert reaction
(i.e., white-coat reaction of the heart rate) through transient
activation or hypersensitivity of the sympathetic nervous system to stress. If so, these reactions might partly reflect the development of obesity, insulin ­resistance, and diabetes mellitus.
From the epidemiological perspective, clarifying the relationship between office heart rate, self-measured home heart rate,
and ambulatory heart rate and the development of metabolic
disorders may help us understand the relationship between
sympathetic nervous activity and the development of metabolic disorders. Therefore, further studies need to investigate
the relationship between sympathetic nervous system activity
and the development of obesity, insulin resistance, and diabetes
mellitus. Additionally, heart rate is controlled not only by sympathetic nervous system but also by parasympathetic nervous
system or a balance between sympathetic and parasympathetic
nerve activities. Therefore, heart rate variability and baroreflex
sensitivity analysis need to clarify the contribution of sympathetic and parasympathetic nerve activities to the development
of obesity, insulin resistance, and diabetes mellitus.
Disclosure: The authors declared no conflict of interest.
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Ohmori K, Hoshi H, Hashimoto J, Satoh H, Tsuji I, Imai Y. Prognostic value of home
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5. Hozawa A, Inoue R, Ohkubo T, Kikuya M, Metoki H, Asayama K, Hara A, Hirose T,
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1Department of Clinical Pharmacology and Therapeutics, Tohoku University
Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan;
2Department of Pharmacy, Tohoku University Hospital, Sendai, Japan;
3Department of Planning for Drug Development and Clinical Evaluation, Tohoku
University Graduate School of Pharmaceutical Sciences, Sendai, Japan; 4Tohoku
University 21st Century COE Program “Comprehensive Research and Education
Center for Planning of Drug Development and Clinical Evaluation,” Sendai,
Japan. Correspondence: Yutaka Imai ([email protected])
doi:10.1038/ajh.2008.350
© 2009 American Journal of Hypertension, Ltd.
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February 2009 | VOLUME 22 NUMBER 2 | 130 | AMERICAN JOURNAL OF HYPERTENSION