Accuracy of pulse rate derived from 24-h ambulatory blood pressure monitoring compared with heart rate from 24-h Holter-ECG

Background: Resting heart rate (HR) associates with cardiovascular outcomes in the general population and in patients with hypertension and heart failure. The accuracy of pulse rate acquired by 24-h ambulatory blood pressure monitoring (ABPM-PR) in comparison with Holter-ECG HR (Holter-HR) is unknown. Objective: We aimed at investigating the accuracy of ABPM-PR when compared with Holter-HR. Methods and results: The current study included 1500 patients of a general cardiology outpatient unit undergoing simultaneous Holter and ABPM recordings. ABPM-PR differed marginally from Holter-HR by 0.55 bpm for 24-h average [95% confidence interval (CI): 0.37-0.73, P < 0.001], 1.27 bpm for daytime (95% CI: -0.98-1.56, P < 0.001) and 0.63 bpm for night-time (95% CI: 0.40-0.86 bpm; P < 0.001). The absolute delta between 24-h Holter-HR and ABPM-PR was less than 5 and less than 10 bpm in 1363 (91%) and 1458 (97%) patients, respectively. 24-h ABPM-PR more commonly underestimated than overestimated (7 versus 2%) 24-h Holter-HR by at least 5 bpm. The mean difference between Holter-HR and ABPM-PR was higher (+1.9 bpm; 95% CI: 0.9-3.0; P < 0.001) in patients with than without atrial fibrillation. There was no significant difference between Holter-HR and ABPM-PR in patients without supraventricular or ventricular extrasystoles (both P >= 0.750). Conclusion: ABPM-PR did not differ clinically meaningful from Holter-HR recordings in most patients and might be useful for risk prediction in hypertension.