Elevated heart rate in cardiovascular diseases: a target for treatment?
Heart rate is a major determinant of myocardial oxygen consumption and of cardiac work, and thus reduction of heart rate may represent an important strategy for the treatment of patients with a wide range of cardiac disorders. In addition, several experimental lines of research point to high heart rate as an important risk factor for atherosclerosis and, thus, pharmacologic heart rate reduction could prevent or retard the development of atherosclerotic plaques and increase survival. Today, in patients with acute or chronic coronary syndromes or with congestive heart failure, reducing heart rate is a generally accepted treatment modality. Up to now, no human study has been performed to demonstrate the efficacy and the risk-benefit ratio of cardiac slowing in patients without cardiac disorders. However, recent retrospective analyses of the INternational VErapamil-SR/trandolapril STudy and the Paris Prospective Study 1 provided promising results. Treatment of high heart rate in healthy subjects appears to be premature, but in clinical conditions such as hypertension or diabetes, the reduction of elevated heart rate appears a desirable additional goal of therapy.
Palatini
Paolo
P
Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy. palatini@unipd.it
D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000503:physiopathology; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001552:Benzazepines / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000503:physiopathology*; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D000077550:Ivabradine; D008019:Life Style; D012307:Risk Factors; D013610:Tachycardia / Q000188:drug therapy / Q000503:physiopathology
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D001552:Benzazepines; D002121:Calcium Channel Blockers; D000077550:Ivabradine