The Effects of Hypertension Treatment on Heart Rate Variability: A Scoping Review

This scoping review systematically gathered and synthesized evidence on the effects of antihypertensives on heart rate variability (HRV) in patients with hypertension (HTN). Antihypertensives are the cornerstone of blood pressure (BP) control, yet their influence on HRV, a marker of autonomic function and a predictor of cardiovascular outcomes, remains incompletely understood. A scoping review approach was selected to map the breadth of available evidence and identify knowledge gaps, focusing on randomized controlled trials to maximize internal validity. A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review (PRISMA-ScR) guidelines. EMBASE, Ovid Medline, Web of Science, and CINAHL were searched for randomized controlled trials published between 1995 and 2021. Only English-language, peer-reviewed studies were included; gray literature was excluded. Twenty-nine trials involving 2,230 participants were included, though designs were heterogeneous in duration and population characteristics. HRV was variably assessed using time-domain, frequency-domain, and nonlinear measures. Beta-blockers and non-dihydropyridine calcium channel blockers consistently enhanced parasympathetic activity and improved HRV. Angiotensin receptor blockers improved HRV in patients with concomitant metabolic syndrome, whereas alpha-1 antagonists showed limited but positive effects. Angiotensin-converting enzyme inhibitors and thiazide diuretics demonstrated minimal impact on HRV. No formal risk of bias assessment was performed, consistent with scoping methodology. The effect of antihypertensive therapy on HRV is drug-class dependent, with beta-blockers and non-dihydropyridine calcium channel blockers showing the most consistent benefits. Evidence-related gaps remain, particularly regarding under-studied drug classes, heterogeneous HRV measurement methods, and limited trial size. These findings highlight the potential role of HRV as a therapeutic consideration in HTN management and underscore the need for targeted research on under-studied drug classes.