Resting heart rate in cardiovascular disease.
The importance of resting heart rate (HR) as a prognostic factor and potential therapeutic target is not yet generally accepted. Recent large epidemiologic studies have confirmed earlier studies that showed resting HR to be an independent predictor of cardiovascular and all-cause mortality in men and women with and without diagnosed cardiovascular disease. Clinical trial data suggest that HR reduction itself is an important mechanism of benefit of beta-blockers and other heart-rate lowering drugs used after acute myocardial infarction, in chronic heart failure, and in stable angina pectoris. Pathophysiological studies indicate that a relatively high HR has direct detrimental effects on the progression of coronary atherosclerosis, on the occurrence of myocardial ischemia and ventricular arrhythmias, and on left ventricular function. Studies have found a continuous increase in risk with HR above 60 beats/min. Although it may be difficult to define an optimal HR for a given individual, it seems desirable to maintain resting HR substantially below the traditionally defined tachycardia threshold of 90 or 100 beats/min. These findings suggest that the potential role of HR and its modulation should be considered in future cardiovascular guidance documents.
Fox
Kim
K
Royal Brompton Hospital, Sydney Street, London SW3 6NP, England. kfox@rbh.nthames.nhs.uk
Borer
Jeffrey S
JS
Camm
A John
AJ
Danchin
Nicolas
N
Ferrari
Roberto
R
Lopez Sendon
Jose L
JL
Steg
Philippe Gabriel
PG
Tardif
Jean-Claude
JC
Tavazzi
Luigi
L
Tendera
Michal
M
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology; D000818:Animals; D001145:Arrhythmias, Cardiac / Q000188:drug therapy / Q000503:physiopathology; D002121:Calcium Channel Blockers / Q000494:pharmacology; D002227:Carbazoles / Q000627:therapeutic use; D002303:Cardiac Output, Low / Q000401:mortality; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D000077261:Carvedilol; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000503:physiopathology; D003327:Coronary Disease / Q000401:mortality / Q000503:physiopathology; D005080:Exercise Test; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008790:Metoprolol / Q000627:therapeutic use; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality; D017202:Myocardial Ischemia / Q000503:physiopathology; D011379:Prognosis; D011412:Propanolamines / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D013999:Timolol / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D013999:Timolol; D008790:Metoprolol