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High Heart Rate, Sympathetic Overdrive, and Cardiovascular Risk in Hypertension.

Guido Grassi1, C Venkata S Ram2, Paolo Palatini3

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The American Journal of Cardiology
|September 25, 2025
PubMed
Summary
This summary is machine-generated.

Elevated resting heart rate in hypertension signifies sympathetic overactivity, leading to organ damage and increased cardiovascular events. Managing heart rate is crucial for better hypertension outcomes.

Keywords:
antihypertensive drugscardiovascular riskheart ratehypertensionsympathetic nervous system

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Area of Science:

  • Cardiology
  • Hypertension Research
  • Clinical Practice

Background:

  • Elevated resting heart rate (RHR) is common in essential hypertension.
  • RHR > 80 bpm indicates sympathetic overactivity, linked to poor cardiovascular outcomes.
  • This overactivity contributes to hypertension-mediated organ damage and increased mortality.

Purpose of the Study:

  • To review the pathophysiology of elevated RHR in hypertension.
  • To examine the clinical impact of elevated RHR as a cardiovascular risk factor.
  • To discuss therapeutic strategies for managing elevated RHR in hypertensive patients.

Main Methods:

  • Comprehensive literature review.
  • Analysis of pathophysiological mechanisms.
  • Evaluation of clinical studies and outcomes.

Main Results:

  • Elevated RHR is associated with cardiac hypertrophy, endothelial dysfunction, and renal damage.
  • Higher RHR independently predicts myocardial infarction, heart failure, and stroke.
  • Increased cardiovascular mortality is linked to elevated RHR in hypertensive individuals.

Conclusions:

  • Elevated RHR is an independent cardiovascular risk factor in hypertension.
  • Sympathetic overactivity underlies the adverse effects of high RHR.
  • Therapeutic targeting of RHR may improve cardiovascular outcomes in hypertension.