Abstract
BackgroundData from large epidemiological studies suggest that elevated heart rate is independently associated with cardiovascular and all-cause mortality in patients with hypertension and in those with established cardiovascular disease. Clinical trial findings also suggest that the favorable effects of beta-blockers and other heart rate–lowering agents in patients with acute myocardial infarction and congestive heart failure may be, at least in part, due to their heart rate–lowering effects. Contemporary clinical outcome prediction models such as the Global Registry of Acute Coronary Events (GRACE) score include admission heart rate as an independent risk factor.AimsThis article critically reviews the key epidemiology concerning heart rate and cardiovascular risk, potential mechanisms through which an elevated resting heart rate may be disadvantageous and evaluates clinical trial outcomes associated with pharmacological reduction in resting heart rate.ConclusionsProspective randomised data from patients with significant coronary heart disease or heart failure suggest that intervention to reduce heart rate in those with a resting heart rate >70 bpm may reduce cardiovascular risk. Given the established observational data and randomised trial evidence, it now appears appropriate to include reduction of elevated resting heart rate by lifestyle +/− pharmacological therapy as part of a secondary prevention strategy in patients with cardiovascular disease.
Highlights
Epidemiological data over the last six decades have found that elevated resting heart rate (RHR) may be associated with increased risk of all-cause mortality and cardiovascular (CV) mortality, both in the general population [1], and in those with established CV disease [2,3,4]
RHR is included in clinical risk prediction models such as the Global Registry of Acute Coronary Events (GRACE) score for patients with acute coronary syndrome, but its role as an independent risk factor and therapeutic target for the management of CV disease is less clear [5]
The aim of this article is to critically review the evidence regarding the prognostic implications of elevated RHR in patients with hypertension and established CV disease, the mechanisms through which an elevated RHR may be disadvantageous, and how reduction in elevated RHR may be of potential benefit
Summary
Data from large epidemiological studies suggest that elevated heart rate is independently associated with cardiovascular and all-cause mortality in patients with hypertension and in those with established cardiovascular disease. Aims: This article critically reviews the key epidemiology concerning heart rate and cardiovascular risk, potential mechanisms through which an elevated resting heart rate may be disadvantageous and evaluates clinical trial outcomes associated with pharmacological reduction in resting heart rate. Conclusions: Prospective randomised data from patients with significant coronary heart disease or heart failure suggest that intervention to reduce heart rate in those with a resting heart rate >70 bpm may reduce cardiovascular risk. Given the established observational data and randomised trial evidence, it appears appropriate to include reduction of elevated resting heart rate by lifestyle +/À pharmacological therapy as part of a secondary prevention strategy in patients with cardiovascular disease
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