title: When an Increase in Central Systolic Pressure Overrides the Benefits of Heart Rate Lowering.
abstract: An elevated resting heart rate has been unequivocally linked to adverse cardiovascular events. Conversely, a physiologically low heart rate may confer longevity benefits. Moreover, pharmacological heart rate lowering reduces cardiovascular outcomes in patients with heart failure, with the magnitude of the reduction associated with survival benefit. In contrast, pharmacological heart rate lowering paradoxically increases cardiovascular events in hypertension, possibly because it elicits a ventricular-vascular mismatch, leading to increased central systolic blood pressure (BP). By the same hemodynamic mechanism, pharmacological heart rate lowering also engenders an increase in central (aortic) BP in coronary heart disease and, as a consequence, fails to decrease myocardial oxygen consumption. Whether in heart failure, hypertension, or coronary heart disease, or even athletes, heart rate lowering consistently increases central systolic pressure. The increase in central systolic BP is prone to abolish the potential benefits of heart rate lowering interventions, possibly accounting for failure to reduce outcomes in patients with hypertension and coronary artery disease.
authors: Department of Cardiology and Clinical Research, University Hospital, Bern, Switzerland; Jagiellonian University, Krakow, Poland; Division of Cardiology, Mount Sinai Health Medical Center, Icahn School of Medicine, New York, New York. Electronic address: messerli.f@gmail.com.
authors: Franz H
authors: FH
authors: Messerli
authors: Department of Cardiology and Clinical Research, University Hospital, Bern, Switzerland.
authors: Stefano F
authors: SF
authors: Rimoldi
authors: The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York.
authors: Sripal
authors: S
authors: Bangalore
authors: Division of Cardiology, Mount Sinai St. Luke's and West Hospitals, New York, New York.
authors: Chirag
authors: C
authors: Bavishi
authors: Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France.
authors: Stephane
authors: S
authors: Laurent
mesh_terms: D000959:Antihypertensive Agents / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D013599:Systole
chemical_list: D000959:Antihypertensive Agents
keywords: beta-blockers; blood pressure; coronary artery disease; heart failure; hypertension; ivabradine