
Increased heart rate and cardiovascular risk in hypertension and diabetes
High resting heart rate increases the risk of cardiovascular morbidity and mortality in the general population, as well as in those with hypertension, and in those with type 2 diabetes. Drugs that increase the heart rate may adversely affect cardiovascular health
Population studies have shown that there is a relationship between high resting heart rate and increased risk of cardiovascular events and mortality. This has also been obvious in most studies in patients with hypertension - findings summarized in a report from a Consensus Meeting of the European Society of Hypertension in 2005.1 This report was updated in 2016 in a statement from the Second Consensus Conference, which concluded that heart rate measurement should be included in the routine assessment of the hypertensive patient.2 A similar view was reported from a group reviewing publications from the Asia Pacific region.3
An analysis of prospective studies in patients with hypertension found that night-time heart rate measured by ambulatory recordings was a better predictor of mortality than elevated heart rate in the clinic.4 The analysis included 7602 hypertensive patients with ambulatory blood pressure (BP) and heart rate recordings from 6 prospective studies in Italy, Japan and Australia. They defined tachycardia as an office heart rate >85 beats/minute or a night-time heart rate >76 beats/minute (these represented the upper quintiles). Patients with elevated heart rate in the clinic but normal night-time heart rate were considered to have white-coat tachycardia whereas those with normal clinic heart rate but
Continue
reading