Significance, prognostic value and management of heart rate in hypertension.
Many epidemiological studies have demonstrated that resting heart rate is a risk marker but also a risk factor in patients with coronary artery disease and heart failure. In hypertensive subjects free from overt cardiac disease, the question has been less frequently addressed. A few cohort studies have shown that hypertensive patients with a high resting heart rate have an increased risk of all-cause and cardiovascular death. However, intervention trials have not demonstrated that lowering the heart rate is beneficial in hypertensive subjects. Studies with an assessment of ambulatory heart rate tend to demonstrate a better association between cardiovascular outcomes and variables, including nighttime heart rate. Clinical trials comparing beta-blockers with non-slowing antihypertensive drugs have not demonstrated the superiority of the former. Finally, an elevated resting heart rate in hypertensive subjects free from overt cardiac disease seems to be more a risk marker than a risk factor. Although these patients are at high risk, no scientific data exist to support targeting heart rate. In this review, we describe the pathophysiological effects of heart rate, including vascular cell signalling, link with sympathetic activity and influence on central blood pressure, and the prognostic value and management of HR in hypertensive patients free from overt cardiac diseases.
Cardiology Department, European Society of Hypertension Excellence Centre, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Génomique Fonctionnelle de l'Hypertension Artérielle, EA 4173, Université Claude-Bernard Lyon-1, Villeurbanne, France; Hôpital Nord-Ouest, Villefranche-sur-Saône, France. Electronic address: pycourand@hotmail.com.
Pierre-Yves
PY
Courand
Cardiology Department, European Society of Hypertension Excellence Centre, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Génomique Fonctionnelle de l'Hypertension Artérielle, EA 4173, Université Claude-Bernard Lyon-1, Villeurbanne, France; Hôpital Nord-Ouest, Villefranche-sur-Saône, France.
Pierre
P
Lantelme
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D000959:Antihypertensive Agents
Fréquence cardiaque; Heart rate; Hypertension; Mortality; Mortalité; Prognostic value; Valeur pronostique