Aging, Resting Pulse Rate, and Longevity

Jochanan Stessman, MD; Jeremy M. Jacobs, MBBS; Irit Stessman-Lande, BMedSci; Dan Gilon, MD; David Leibowitz, MD

Disclosures

J Am Geriatr Soc. 2013;61(1):40-45. 

In This Article

Abstract and Introduction

Abstract

Objectives: To examine the relationship between resting pulse rate (RPR) and longevity in individuals aged 70 to 90.

Design: The Jerusalem Longitudinal Cohort Study (1990–2010) is a prospective longitudinal study of a representative cohort born in 1920–21.

Setting: Home-based comprehensive assessment in 1990, 1998, and 2005.

Participants: Individuals aged 70 (n = 453), 78 (n = 856), and 85 (n = 1,044), with follow-up to age 90.

Measurements: Comprehensive assessment included average RPR, beta-blocker usage, and physical activity level. Mortality data were collected from the Ministry of Interior from 1990 to 2010.

Methods: Cox proportional hazards ratios (HRs) were determined for RPR (continuous variable), adjusting for sex, education, diabetes mellitus, ischemic heart disease, congestive heart failure, hypertension, kidney disease, anemia, physical activity, body mass index, self-rated health, dementia, beta-blocker use, and an interaction term for RPR by beta-blocker use.

Results: Mean RPR was 75.1 ± 9.9 at 70, 74.5 ± 10.9 at 78, and 68.5 ± 10.5 at 85 in women and 74.3 ± 10.7 at 70, 73.1 ± 11.2 at 78, and 65.2 ± 10.5 at 85 in men, with a significant decline from 78 to 85 for both sexes. In participants not taking beta-blockers followed up from 70 to 77, 78 to 84, and 85 to 90, mean RPR was lower in survivors than nonsurvivors for women (75.8 ± 9.2 vs 83.5 ± 10.9, P < .001; 75.2 ± 9.8 vs 79.9 ± 12.6, P = .004; 71.5 ± 9.9 vs 74.6 ± 10.7, P = .02, respectively) and men (75.2 ± 10.3 vs 75.2 ± 10.9, P = .98; 73.5 ± 10.1 vs 77.2 ± 12.1, P = .005; 67.1 ± 9.5 vs 70.4 ± 11.7, P = .01, respectively). Adjusted HRs for mortality per 10-beat increase in RPR during follow-up were 1.13 (95% confidence interval (CI) = 0.87–1.47) for 70 to 77, 1.35 (95% CI = 1.11–1.65) for 78 to 84, and 1.17 (95% CI = 1.01–1.37) for 85 to 90.

Conclusion: RPR declines in the oldest old, and this decline is associated with greater longevity. It may serve as a simple prognostic marker in the oldest old.

Introduction

It appears to be generally accepted that resting pulse rate (RPR) remains unchanged in older people.[1,2] This stands in contrast to the numerous hallmarks of cardiovascular aging, which include progressive increases in systolic blood pressure, pulse pressure, pulse wave velocity, and left ventricular mass and greater incidence of atrial fibrillation and coronary artery disease. Reproducible age-related decreases are seen in maximal heart rate, reflex responses of heart rate, and heart rate variability, as well as blunted response to beta-adrenergic stimuli and endothelium–mediated vasodilator compounds.[1,3,4]

Resting pulse rate falls progressively from approximately 140 beats per minute (bpm) in neonates to stabilize gradually at normal adult levels of 50 to 90 bpm.[5,6] In individuals aged 65 and older, and particularly in those aged 85 and older, evidence concerning the trajectory of RPR over time is particularly sparse, and the consensus appears to be that, in the absence of pathology, RPR continues unchanged from earlier adult life. Longitudinal data from the Framingham Study suggest that RPR continues to decline with advancing age, particularly in the oldest old.[7,8]

The relationship between RPR and mortality has been described in general adult populations and in individuals with cardiovascular disease,[9–13] with higher RPR being predictive of poorer survival. It remains to be clarified whether RPR in older people, particularly in the oldest old, predicts longevity. Existing data are conflicting. The few studies to examine this question in individuals aged 65 and have generally underrepresented the "oldest old," only rarely have been based upon longitudinal data, and have largely been conducted in an institutional or office setting, possibly contributing to a biased study population, because elderly adults may have difficulty leaving their homes.[14–18]

The objectives of this study were to describe the RPR in an age-homogenous representative sample of community-dwelling older people followed from age 70 to 85 and to examine the relationship between RPR and longevity in older people from age 70 to 90.

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