Heart Rate in Hypertension: Review and Expert Opinion
Heart rate (HR) is strongly associated with both peripheral and central blood pressures. This association has implications in hypertension (HTN) prognosis and management. Elevated HR in HTN further elevates the risk of adverse outcomes. Evidence suggests that HR is an independent risk factor for car...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | International Journal of Hypertension |
| Online Access: | http://dx.doi.org/10.1155/2019/2087064 |
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| author | Jamshed Dalal Arup Dasbiswas Immaneni Sathyamurthy Srinivasa Rao Maddury Prafulla Kerkar Sandeep Bansal Joy Thomas Sankar Chandra Mandal Soura Mookerjee Sivakadaksham Natarajan Viveka Kumar Nishith Chandra Aziz Khan R. Vijayakumar J. P. S. Sawhney |
| author_facet | Jamshed Dalal Arup Dasbiswas Immaneni Sathyamurthy Srinivasa Rao Maddury Prafulla Kerkar Sandeep Bansal Joy Thomas Sankar Chandra Mandal Soura Mookerjee Sivakadaksham Natarajan Viveka Kumar Nishith Chandra Aziz Khan R. Vijayakumar J. P. S. Sawhney |
| author_sort | Jamshed Dalal |
| collection | DOAJ |
| description | Heart rate (HR) is strongly associated with both peripheral and central blood pressures. This association has implications in hypertension (HTN) prognosis and management. Elevated HR in HTN further elevates the risk of adverse outcomes. Evidence suggests that HR is an independent risk factor for cardiovascular (CV) and total mortality in patients with HTN. With objective to engage physicians and researchers in India to identify and discuss the implications related to HR management in HTN, experts in the HTN management provided consensus recommendations. The key expert recommendations included the following. (i) Heart rate (HR) has inverse relationship with the central aortic pressure, whereby reduction in HR is associated with an increase in central aortic pressure. This counter-balances the benefit of HR reduction with the harmful effects of rising central aortic pressure. (ii) Increase in the resting HR is associated with increased risk of incident HTN. A linear association between the two is observed especially in individuals with HR >80 bpm. (iii) A reduced HR variability further adds to the propensity for the development of HTN, especially in men. (iv) Each 10 beats per minute increase in the resting HR can substantially increase the risk of adverse CV and mortality outcomes. On treatment HR provides a better prognostic guide. (v) Ambulatory HR with day-time and night-time HR evaluation may also suggest different impact on outcomes. (vi) Target HR in patients with HTN remains unclear. Generally, HR<70 bpm on beta blocker (BB) treatment is advised which may be further lowered in patients with comorbidities like heart failure and coronary artery disease. (vii) Adopting healthy lifestyle approaches to keep check on BP and HR is essential. (viii) Use selective beta-1 blocker in symptomatic cases with elevated HR beyond 80-85 mmHg. BBs are expected to benefit by lowering HR by nearly 10 bpm. Preference should be given to newer beta-blockers which reduce HR and both peripheral and central blood pressure to derive comprehensive advantage of this dual action. (ix) It still remains unclear whether reducing HR in HTN without comorbidities alters the CV and mortality outcomes. |
| format | Article |
| id | doaj-art-04e15743c46b4c20ad6eda594a29140d |
| institution | Kabale University |
| issn | 2090-0384 2090-0392 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Hypertension |
| spelling | doaj-art-04e15743c46b4c20ad6eda594a29140d2025-02-03T05:44:47ZengWileyInternational Journal of Hypertension2090-03842090-03922019-01-01201910.1155/2019/20870642087064Heart Rate in Hypertension: Review and Expert OpinionJamshed Dalal0Arup Dasbiswas1Immaneni Sathyamurthy2Srinivasa Rao Maddury3Prafulla Kerkar4Sandeep Bansal5Joy Thomas6Sankar Chandra Mandal7Soura Mookerjee8Sivakadaksham Natarajan9Viveka Kumar10Nishith Chandra11Aziz Khan12R. Vijayakumar13J. P. S. Sawhney14Centre for Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital, Mumbai, IndiaDepartment of Cardiology, NRS Medical College, Kolkata, West Bengal, IndiaDept. of Cardiology, Apollo Hospitals, Chennai, IndiaDepartment of Cardiology, Care Hospitals, Hyderabad, IndiaDepartment of Cardiology, KEM Hospital, Mumbai, Maharashtra, IndiaDepartment of Cardiology, Safdarjung Medical College, Delhi, IndiaDr. Joy Thomas Heart Care, Bharathi Salai, Mogappair West, Chennai, IndiaBelle Vue Clinic, Brahmachari Street, Kolkata, IndiaWelkin Medicare, Garia, Kolkata, IndiaSiva's Cardio Diabetic Care, Royapettah, Chennai, IndiaMax Hospital, Saket, New Delhi, IndiaFortis Escorts Hospital, New Delhi, IndiaCrescent Hospital & Heart Centre, Dhantoli, Nagpur, Maharashtra, IndiaBillroth Hospital, Mandaveli, Chennai, IndiaDept. of Cardiology, Sir Ganga Ram Hospital, New Delhi, IndiaHeart rate (HR) is strongly associated with both peripheral and central blood pressures. This association has implications in hypertension (HTN) prognosis and management. Elevated HR in HTN further elevates the risk of adverse outcomes. Evidence suggests that HR is an independent risk factor for cardiovascular (CV) and total mortality in patients with HTN. With objective to engage physicians and researchers in India to identify and discuss the implications related to HR management in HTN, experts in the HTN management provided consensus recommendations. The key expert recommendations included the following. (i) Heart rate (HR) has inverse relationship with the central aortic pressure, whereby reduction in HR is associated with an increase in central aortic pressure. This counter-balances the benefit of HR reduction with the harmful effects of rising central aortic pressure. (ii) Increase in the resting HR is associated with increased risk of incident HTN. A linear association between the two is observed especially in individuals with HR >80 bpm. (iii) A reduced HR variability further adds to the propensity for the development of HTN, especially in men. (iv) Each 10 beats per minute increase in the resting HR can substantially increase the risk of adverse CV and mortality outcomes. On treatment HR provides a better prognostic guide. (v) Ambulatory HR with day-time and night-time HR evaluation may also suggest different impact on outcomes. (vi) Target HR in patients with HTN remains unclear. Generally, HR<70 bpm on beta blocker (BB) treatment is advised which may be further lowered in patients with comorbidities like heart failure and coronary artery disease. (vii) Adopting healthy lifestyle approaches to keep check on BP and HR is essential. (viii) Use selective beta-1 blocker in symptomatic cases with elevated HR beyond 80-85 mmHg. BBs are expected to benefit by lowering HR by nearly 10 bpm. Preference should be given to newer beta-blockers which reduce HR and both peripheral and central blood pressure to derive comprehensive advantage of this dual action. (ix) It still remains unclear whether reducing HR in HTN without comorbidities alters the CV and mortality outcomes.http://dx.doi.org/10.1155/2019/2087064 |
| spellingShingle | Jamshed Dalal Arup Dasbiswas Immaneni Sathyamurthy Srinivasa Rao Maddury Prafulla Kerkar Sandeep Bansal Joy Thomas Sankar Chandra Mandal Soura Mookerjee Sivakadaksham Natarajan Viveka Kumar Nishith Chandra Aziz Khan R. Vijayakumar J. P. S. Sawhney Heart Rate in Hypertension: Review and Expert Opinion International Journal of Hypertension |
| title | Heart Rate in Hypertension: Review and Expert Opinion |
| title_full | Heart Rate in Hypertension: Review and Expert Opinion |
| title_fullStr | Heart Rate in Hypertension: Review and Expert Opinion |
| title_full_unstemmed | Heart Rate in Hypertension: Review and Expert Opinion |
| title_short | Heart Rate in Hypertension: Review and Expert Opinion |
| title_sort | heart rate in hypertension review and expert opinion |
| url | http://dx.doi.org/10.1155/2019/2087064 |
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