Skip to main content

Advertisement

SpringerLink
Log in

Relevance of heart rate as a risk factor in hypertension

  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Numerous studies have shown that resting heart rate is closely correlated with blood pressure and that it is prospectively related to the development of hypertension. Moreover, there is mounting evidence to indicate that a high heart rate is associated with increased cardiovascular morbidity and mortality. In this respect, heart rate can be considered both as a marker of risk and as an independent factor in the induction of risk. Sympathetic overactivity seems to be responsible for the increase in blood pressure and hematocrit, and for the metabolic abnormalities often observed in subjects with tachycardia. Experimental studies in monkeys have shown that heart rate can also exert a direct atherogenic action on the arteries through increased wall stress. Furthermore, tachycardia can favor the occurrence of ventricular arrhythmias and sudden death. Reduction of heart rate appears to be a reasonable additional goal of antihypertensive therapy, especially in subjects with increased sympathetic tone. Nondihydropyridine calcium antagonists and drugs with agonistic properties at the I1-imidazoline receptors of the rostral ventrolateral medulla may be drugs of choice for this purpose, but whether they offer a significant morbidity-mortality advantage must be proven in prospective trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Stamler J, Berkson DM, Dyer A, et al.:Relationship of multiple variables to blood pressure: findings from four Chicago epidemiologic studies. In Epidemiology and Control of Hypertension. Edited byPaulO.Miami:Symposia Specialists; 1975:307–352.

    Google Scholar 

  2. Cirillo M, Laurenzi M, Trevisan M, et al.: Hematocrit, blood pressure, and hypertension: the Gubbio Population Study. Hypertension 1992, 20:319–326.

    PubMed  CAS  Google Scholar 

  3. Palatini P, Julius S: Heart rate and the cardiovascular risk. J Hypertens 1997, 15:3–17. This review article highlights the clinical significance of heart rate. The results of all epidemiologic studies focusing on heart rate are summarized, and the possible pathogenetic mechanisms for the connection between high heart rate and cardiovascular morbidity-mortality are elucidated.

    Article  PubMed  CAS  Google Scholar 

  4. Dyer AR, Persky V, Stamler J, et al.: Heart rate as a prognostic factor for coronary heart disease and mortality: findings in three Chicago epidemiologic studies. Am J Epidemiol 1980, 112:736–749.

    PubMed  CAS  Google Scholar 

  5. Palatini P, Casiglia E, Pauletto P, et al.: Relationship of tachycardia with high blood pressure and metabolic abnormalities: a study with mixture analysis in three populations. Hypertension 1997, 30:1267–1273. This study provides evidence for the existence of two subpopulations one with normal and one with a high heart rate, within two general and one hypertensive populations.

    PubMed  CAS  Google Scholar 

  6. Levy RL, White PD, Stroud WD, et al.: Transient tachycardia: prognostic significance alone and in association with transient hypertension. JAMA 1945, 129:585–588.

    Google Scholar 

  7. Garrison RJ, Kannel WB, Stokes J III: Incidence and precursors of hypertension in young adults. Prev Med 1987, 16:235–251.

    Article  PubMed  CAS  Google Scholar 

  8. Reed D, McGee D, Yano K: Biological and social correlates of blood pressure among Japanese men in Hawaii. Hypertension 1982, 4:406–414.

    PubMed  CAS  Google Scholar 

  9. Selby JV, Friedman GD, Quesenberry CPJr: Precursors of essential hypertension: pulmonary function, heart rate, uric acid, serum cholesterol, and other serum chemistries. Am J Epidemiol 1990, 131:1017–1027.

    PubMed  CAS  Google Scholar 

  10. Paffenbarger RSJr, Thorne MC, Wing AL: Chronic disease in former college students—VIII: characteristics in youth predisposing to hypertension in later years. Am J Epidemiol 1968, 88:25–32.

    PubMed  Google Scholar 

  11. Medalie JH, Kahn HA, Neufeld HN, et al.: Five-year myocardial infarction incidence—II: association of single variables to age and birthplace. J Chronic Dis 1973, 26:329–349.

    Article  Google Scholar 

  12. Schroll M, Hagerup LM: Risk factors of myocardial infarction and death in men aged 50 at entry: a ten-year prospective study from the Glostrup population studies. Dan Med Bull 1977, 24:252–255.

    PubMed  CAS  Google Scholar 

  13. Gillum RF, Makuc DM, Feldman JJ: Pulse rate, coronary heart disease, and death: the NHANES I epidemiologic follow-up study. Am Heart J 1991, 121:172–177.

    Article  PubMed  CAS  Google Scholar 

  14. Kannel WB, Kannel C, Paffenbarger RSJr, et al.: Heart rate and cardiovascular mortality: the Framingham Study. Am Heart J 1987, 113:1489–1494.

    Article  PubMed  CAS  Google Scholar 

  15. Aronow WS, Ahn C, Mercando AD, et al.: Association of average heart rate on 24-hour ambulatory electrocardiograms with incidence of new coronary events at 48-month followup in 1311 patients (mean age 81 years) with heart disease and sinus rhythm. Am J Cardiol 1996, 78:1175–1176.

    Article  PubMed  CAS  Google Scholar 

  16. Palatini P, Casiglia E, Julius S, et al.: High heart rate: a risk factor for cardiovascular death in elderly men. Arch Intern Med 1999, 159:585–592.

    Article  PubMed  CAS  Google Scholar 

  17. Gillman MW, Kannel WB, Belanger A, et al.: Influence of heart rate on mortality among persons with hypertension: the Framingham Study. Am Heart J 1993, 125:1148–1154.

    Article  PubMed  CAS  Google Scholar 

  18. Julius S, Pascual AV, London R: Role of parasympathetic inhibition in the hyperkinetic type of borderline hypertension. Circulation 1971, 44:413–418.

    PubMed  CAS  Google Scholar 

  19. Palatini P, Julius S: Association of tachycardia with morbidity and mortality: pathophysiological considerations. J Hum Hypertens 1997, 11:19–27.

    Google Scholar 

  20. Jamerson KA, Julius S, Gudbrandsson T, et al.: Reflex sympathetic activation induces acute insulin resistance in the human forearm. Hypertension 1993, 21:618–623.

    PubMed  CAS  Google Scholar 

  21. Pollare T, Lithell H, Selinus I, et al.: Application of prazosin is associated with an increase of insulin sensitivity in obese patients with hypertension. Diabetologia 1988, 31:415–420.

    Article  PubMed  CAS  Google Scholar 

  22. CohnJN: Relationship of plasma volume changes to resistance and capacitance vessel effects of sympathomimetic amines and angiotensin in man. Clin Sci 1966, 30:267–278.

    PubMed  CAS  Google Scholar 

  23. Julius S, Pascual AV, Abbrecht P, et al.: Effect of beta-adrenergic blockade on plasma volume in human subjects. Proc Soc Exp Biol Med 1972, 140:982–985.

    PubMed  CAS  Google Scholar 

  24. Julius S, Pascual A, Reilly K, et al.: Abnormalities of plasma volume in borderline hypertension. Arch Intern Med 1971, 127:116–119.

    Article  PubMed  CAS  Google Scholar 

  25. Kjeldsen SE, Gjesdal K, Eide I, et al.: Increased beta-thromboglobulin in essential hypertension: interactions between arterial plasma adrenaline, platelet function and blood lipids. Acta Med Scand 1983, 213:369–373.

    Article  PubMed  CAS  Google Scholar 

  26. Julius S, Li Y, Brant D, et al.: Neurogenic pressor episodes fail to cause hypertension, but do induce cardiac hypertrophy. Hypertension 1989, 13:422–429.

    PubMed  CAS  Google Scholar 

  27. Hartford M, Wikstrand J, Wallentin I, et al.: Left ventricular mass in middle-aged men: relationship to blood pressure, sympathetic nervous activity, hormonal and metabolic factors. Clin Exp Hypertens 1983, A5:1429–1451.

    Google Scholar 

  28. Palatini P, Maraglino G, Accurso V, et al.: Impaired left ventricular filling in hypertensive left ventricular hypertrophy as a marker of the presence of an arrhythmogenic substrate. Br Heart J 1995, 73:258–262.

    PubMed  CAS  Google Scholar 

  29. Levy D, Garrison RJ, Savage DD, et al.: Prognostic implications of echocardiographically determined left ventricular mass in the Framingham heart study. N Engl J Med 1990, 322:1561–1566.

    Article  PubMed  CAS  Google Scholar 

  30. PalatiniP: Exercise haemodynamics in the normotensive and the hypertensive subject. Clin Sci 1994, 87:275–287.

    PubMed  CAS  Google Scholar 

  31. Gordon D, Guyton J, Karnovsky N: Intimal alterations in rat aorta induced by stressful stimuli. Lab Invest 1983, 45:14–19.

    Google Scholar 

  32. Beere PA, Glagov S, Zarins CK: Retarding effect of lowered heart rate on coronary atherosclerosis. Science 1984, 226:180–182.

    Article  PubMed  CAS  Google Scholar 

  33. Kaplan JR, Manuck SB, Clarkson TB: The influence of heart rate on coronary artery atherosclerosis. J Cardiovasc Pharmacol 1987, 10:S100-S102.

    Article  PubMed  Google Scholar 

  34. Kaplan JR, Manuck SB, Adams MR, et al.: Inhibition of coronary atherosclerosis by propranolol in behaviorally predisposed monkeys fed an atherogenic diet. Circulation 1987, 76:1364–1372.

    PubMed  CAS  Google Scholar 

  35. Bassiouny HS, Zarins CK, Kadowaki MH, et al.: Hemodynamic stress and experimental aortoiliac atherosclerosis. J Vasc Surg 1994, 19:426–434.

    PubMed  CAS  Google Scholar 

  36. Mangoni AA, Mircoli L, Giannattasio C, et al.: Heart ratedependence of arterial distensibility in vivo. J Hypertens 1996, 14:897–901.

    Article  PubMed  CAS  Google Scholar 

  37. Schwartz PJ, Priori SG:Sympathetic nervous system and cardiac arrhythmias. In Cardiac Electrophysiology: From Cell to Bedside. Edited by ZipesDP,JalifeJ.Philadelphia:WB Saunders; 1990:330–343.

    Google Scholar 

  38. Lown B, Verrier RL: Neural activity and ventricular fibrillation. N Engl J Med 1976, 294:1165.

    Article  PubMed  CAS  Google Scholar 

  39. Persky V, Dyer AR, Leonas J, et al.: Heart rate: a risk factor for cancer? Am J Epidemiol 1981, 114:477–487.

    PubMed  CAS  Google Scholar 

  40. Julius S, Randall OS, Esler MD, et al.: Altered cardiac responsiveness and regulation in the normal cardiac output type of borderline hypertension. Circ Res 1975, 36:I199-I207.

    Google Scholar 

  41. Palatini P, Visentin PA, Mormino P, et al.: Left ventricular performance in the early stages of systemic hypertension. Am J Cardiol 1998, 81:418–423.

    Article  PubMed  CAS  Google Scholar 

  42. Coburn AF, Grey RM, Rivera SM: Observations on the relation of heart rate, life span, weight and mineralization in the digoxintreated A/J mouse. John Hopkins Med J 1971, 128:169–193.

    CAS  Google Scholar 

  43. Teo KK, Yusuf S, Furberg CD: Effects of prophylactic antiarrhythmic drug therapy in acute myocardial infarction: an overview of results from randomized controlled trials. JAMA 1993, 270:1589–1595.

    Article  PubMed  CAS  Google Scholar 

  44. KjekshusJK: Importance of heart rate in determining betablocker efficacy in acute and long-term acute myocardial infarction intervention trials. Am J Cardiol 1986, 57:43F-49F.

    Article  PubMed  CAS  Google Scholar 

  45. KjekshusJK: Comments on beta-blockers: heart rate reduction, a mechanism of action. Eur Heart J 1985, 6(suppl):29.

    Google Scholar 

  46. Packer M, Bristow MR, Cohn JN, for the U.S. Carvedilol Heart Failure Study Group: The effect of Carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 1996, 334:1349–1355.

    Article  PubMed  CAS  Google Scholar 

  47. Nul DR, Doval HC, Grancelli HO, et al.: Heart rate is a marker of amiodarone mortality reduction in severe heart failure. J Am Coll Cardiol 1997, 29:1199–1205.

    Article  PubMed  CAS  Google Scholar 

  48. Collins R, Peto R, MacMahon S, et al.: Blood pressure, stroke, and coronary heart disease. Part 2, short-term reductions in blood pressure: overview of randomized drug trials in their epidemiological context. Lancet 1990, 335:827–838.

    Article  PubMed  CAS  Google Scholar 

  49. Kailasam MT, Parmer RJ, Cervenka JH, et al.: Divergent effects of dihydropyridine and phenylalkylamine calcium channel antagonist classes on autonomic function in human hypertension. Hypertension 1995, 26:143–149.

    PubMed  CAS  Google Scholar 

  50. Luscher TF, Clozel JP, Noll G: Pharmacology of the calcium antagonist mibefradil. J Hypertens 1997, 15:S11-S18.

    Google Scholar 

  51. VanZwietenPA: Centrally acting antihypertensives: a renaissance of interest. Mechanisms and haemodynamics. J Hypertens 1997, 15:S3-S8.

    Article  Google Scholar 

  52. Ernsberger P, Koletsky RJ, Collins LA, et al.: Sympathetic nervous system in salt-sensitive and obese hypertension: amelioration of multiple abnormalities by a central sympatholitic agent. Cardiovasc Drugs Ther 1996, 10:275–282.

    Article  PubMed  Google Scholar 

  53. Ernsberger P, Friedman JE, Koletsky RJ: The I1-Imidazoline receptor: from binding site to therapeutic target in cardiovascular disease. J Hypertens 1997, 15:S9-S23.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinica Medica 4, University of Padova, via Giustiniani 2, 35126, Padova, Italy

    Paolo Palatini MD

  2. Division of Hypertension, University of Michigan, Ann Arbor, Michigan, USA

    Stevo Julius MD, ScD

Authors
  1. Paolo Palatini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stevo Julius MD, ScD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Palatini, P., Julius, S. Relevance of heart rate as a risk factor in hypertension. Current Science Inc 1, 219–224 (1999). https://doi.org/10.1007/s11906-999-0024-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-999-0024-7

Keywords

Search

Navigation