[Resting pulse rate as an indicator of health and disease]

The resting pulse rate appears to be an independent cardiovascular risk factor. The paper reviews the scientific evidence in support of this assertion and discusses how the findings of this simple examination may be put to clinical use.

We have evaluated the relationship between resting pulse rate, cardiovascular disease and mortality based on evidence retrieved by a search in the Medline database.

The resting pulse rate varies with physical fitness, and high intensity training can decrease the resting pulse. A high resting pulse rate is associated with an elevated risk of cardiovascular disease, and a poorer prognosis in established cardiovascular disease. The relationship between a high resting pulse and death from cardiovascular disease can be explained by well-known pathophysiological mechanisms, but more evidence is needed. In particular, we do not know why the associations between pulse rate and health are weaker in females. Physical exercise is beneficial in prevention and often also in the treatment of cardiovascular disease. We do not yet know how much of the beneficial effects of exercise are mediated through a lowered resting pulse.

Taking the resting pulse should form part of prophylactic health monitoring procedures the same way as the monitoring of other cardiovascular risk markers such as blood pressure, lipids, smoking status and weight. Among patients with established cardiovascular disease, the resting pulse rate is an important prognostic marker. An elevated resting pulse rate might be an incitement to recommend increased physical activity.