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: 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. RESULTS: Median follow-up was 6.6 years (IQR 5.8-7.4). A 50% lower xBRS at baseline was independently associated with a 1.31 higher OR (95% CI 1.09-1.57) of developing hypertension at follow-up. No significant associations between the standard deviation normal-to-normal interval (SDNN) or the root mean square of differences in successive normal-to-normal interval (RMSDD), 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 RMSDD. CONCLUSION: In the general population, a lower xBRS is associated with increased odds of developing hypertension, and a steeper increase in SBP over time.