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Tachycardia: an important determinant of coronary risk in hypertension
S Julius1, P Palatini, S D Nesbitt
1Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, USA.
Insights
High heart rate is linked to high blood pressure and predicts mortality. Lowering heart rate may improve outcomes more than blood pressure reduction alone in hypertension treatment.
Area of Science:
- Cardiology
- Hypertension Research
- Autonomic Nervous System Function
Background:
- Heart rate and blood pressure are closely correlated, with high blood pressure often associated with elevated heart rates.
- Fast heart rate is an early indicator of coronary heart disease and a predictor of both cardiovascular and non-cardiovascular mortality, impacting overall longevity.
- The 'hyperkinetic hypertension state,' characterized by elevated cardiac output and high sympathetic tone, affects a significant portion of individuals with borderline hypertension.
Purpose of the Study:
- To review the association between heart rate and hypertension.
- To explore the role of sympathetic and parasympathetic tone in this relationship.
- To discuss the implications of heart rate elevation as a risk factor for mortality and cardiovascular disease.
Main Methods:
- Review of existing literature and data from population studies, including the Tecumseh Blood Pressure study.
- Analysis of the relationship between heart rate, blood pressure, and sympathetic nervous system activity.
- Discussion of potential mechanisms linking heart rate to metabolic factors and cardiovascular pathology.
Main Results:
- Elevated heart rate is observed in individuals with hypertension and can be an early indicator of cardiovascular risk.
- Tachycardia (fast heart rate) is a marker of high sympathetic tone, which may mediate associations with insulin resistance, dyslipidemia, and obesity.
- High heart rate may contribute to cardiac strain, atherosclerosis, and increased risk of sudden death and arrhythmias.
Conclusions:
- Heart rate elevation is not just a symptom but can be a contributing factor to cardiovascular damage and mortality.
- Reducing heart rate through pharmacological and non-pharmacological interventions may be a crucial therapeutic strategy in hypertension management, potentially exceeding the benefits of blood pressure reduction alone for coronary mortality.
Abstract:
Heart rate and blood pressure are highly correlated and in large population studies, individuals with high blood pressure tend to have high heart rates. Fast heart rate precedes the development of high blood pressure and serves as an early indicator of coronary heart disease. Not only does the heart rate predict coronary mortality, but also the non-cardiovascular mortality and is, therefore, an overall predictor of longevity. In the Tecumseh Blood Pressure study, we have seen that 37% of all patients with borderline hypertension have the 'hyperkinetic hypertension state', which consists of elevated cardiac output, high heart rate, high sympathetic tone, and decreased parasympathetic tone. In this population, evidence of high heart rate exists in these individuals as children, and persists through early adulthood. This suggests that tachycardia is a reliable marker of high sympathetic tone. High sympathetic tone might be the mechanism whereby heart rate is associated with high insulin, insulin resistance, dyslipidemia, high hematocrit and excess weight. These mechanisms are discussed in details in this review. Tachycardia is a strong risk factor for sudden death and arrythmia. Heart rate, as one of the prime determinants of cardiac work, may contribute to greater cardiac strain. Animal studies have shown that a higher heart rate may be associated with a greater development of atherosclerotic plaque in coronary vasculature. Therefore, heart rate elevation is not merely a sign of underlying pathology, but it may also cause further damage that leads to increased mortality. In the treatment of hypertension, reducing heart rate by pharmacologic and non-pharmacologic measures may have a greater effect on coronary mortality than blood pressure reduction alone.