Aims: Cross-correlation baroreflex sensitivity (xBRS) and heart rate variability (HRV) are measures of autonomic cardiac control and are associated with hypertension. However, their value in predicting new-onset hypertension and changes in systolic blood pressure (SBP) remains elusive.
Methods and results: We used longitudinal data of participants with and without a history of cardiovascular disease from the HEalthy Life In an Urban Setting (HELIUS) study. A non-invasive continuous finger blood pressure measurement at baseline was used to calculate xBRS and HRV. In normotensives at baseline, we calculated the odds ratio (OR) of developing hypertension at follow-up. In the full cohort, we assessed the change in SBP between baseline and follow-up using linear regression. Subgroup analyses were performed in the younger (<50 years) and older (≥50 years) participants. Median follow-up was 6.6 years (interquartile range 5.8-7.4). A 50% lower xBRS at baseline was independently associated with a 1.31 higher OR [95% confidence interval (CI) 1.09-1.57] of developing hypertension at follow-up. No significant associations between the standard deviation of the normal-to-normal interval (SDNN) or the square root of the mean of successive differences between adjacent normal-to-normal intervals (RMSSD), and new-onset hypertension were found. Compared to the lowest tertile, an xBRS in the highest tertile was associated with a 3.61 mmHg (95% CI 2.50-4.71) higher increase in SBP over time, whereas this was 1.11 mmHg (95% CI 0.12-2.09) and 1.76 mmHg (95% CI 0.73-2.79) for SDNN and RMSSD.
Conclusion: In the general population, a lower xBRS is associated with increased odds of developing hypertension, and a steeper increase in SBP over time.
Keywords: Cross-correlation baroreflex sensitivity; HELIUS; Heart rate variability; Hypertension; Systolic blood pressure.
Cross-correlation baroreflex sensitivity (xBRS) and heart rate variability (HRV) are associated with cardiac autonomic function, and they predict blood pressure increases in a multi-ethnic population, whereas only xBRS additionally predicts new-onset hypertension in normotensives.The prognostic value of xBRS on new-onset hypertension has not been investigated yet. We show that xBRS independently predicts new-onset hypertension, and both xBRS and heart rate variability HRV predict blood pressure increases in a large heterogenous cohort.Our findings may hold promise for the development of wearable devices where non-invasive assessment of xBRS can be implemented.
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.