Combination of Arterial Hypertension and Increased Heart Rate as a Significant Cardiovascular Risk Factor

Heart Rate as a Risk and Prognostic Factor

Obesity, smoking, alcoholism, diabetes mellitus, and renal diseases significantly contribute to the development of cardiovascular diseases. Increased resting heart rate (HR) is another risk factor that is often overlooked by medical professionals. Resting HR in a healthy adult should be between 60–100 beats/min. An increase in HR values (even within this range) is associated with a significant risk for the development of arterial hypertension and other cardiovascular complications.

Causes of increased resting HR may include emotional stress, fever, anemia, hypovolemia, or the effects of addictive substances and certain medications. In the management of resting tachycardia, it is essential to rule out all causes of secondary HR increase. In many cases, however, the etiology of tachycardia remains unknown.

Increased HR in Patients with Arterial Hypertension

Every patient should be properly informed about the necessity and method of monitoring heart rate, and they should measure it at home. Monitoring of hypertensive patients should not be limited to blood pressure measurements alone. Patients with hypertension and accelerated heart action require intervention that has the potential to address both issues. Non-pharmacological therapy includes lifestyle improvements, such as adequate and regular physical activity, quitting smoking, reducing alcohol and caffeine intake, and weight loss. Pharmacological therapy aiming to reduce HR should be initiated in symptomatic patients. Beta-adrenergic receptor blockers are most commonly used.

Killing Two Birds with One Stone − The Effect of Beta-blockers on Blood Pressure and Tachycardia

From the group of beta-blockers, we primarily use selective β₁-blockers (cardioselective beta-blockers). These drugs reduce heart rate, conduction system conduction, contraction strength, and myocardial excitability. They can be used in patients with sinus tachycardia caused by emotional influences, in patients after myocardial infarction, with chronic heart failure, and in patients with hyperthyroidism.

Besides slowing down heart action, β₁-blockers also have an antihypertensive effect. Their use in hypertensive patients with resting tachycardia is advantageous because it simultaneously reduces blood pressure and resting heart rate. The cardioprotective effect of β₁-blockers lies in the reduction of myocardial metabolic demands and the risk of serious arrhythmias.

Among the most clinically used representatives of this group is bisoprolol, administered in doses of 1.25–10 mg once daily. Treatment must start with gradual titration and frequent monitoring of basic vital signs during the titration phase.

Measuring Blood Pressure is Not Enough

General practitioners and internists measure blood pressure at every patient visit. Similarly, they should be careful to regularly measure resting heart rate. Every doctor must be aware that increased resting HR is not just a harmless parameter and can precede the development of arterial hypertension.

Focusing only on individuals with known cardiovascular risk factors is not enough, as patients with increased resting HR are often „less noticeable“. This primarily involves those whose tachycardia is caused by emotional influences. These patients are often exposed to increased work stress or exhibit psychological issues. The presence of arterial hypertension combined with increased resting HR significantly increases cardiovascular risk, and an appropriate and timely solution can prevent the development of complications.

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Sources:
1. Dalal J., Dasbiswas A., Sathyamurthy I. et al. Heart rate in hypertension: review and expert opinion. Int J Hypertens 2019 Feb 19; 2019: 2087064, doi: 10.1155/2019/2087064.
2. Eguchi K. New insight into effects of β-blockers on arterial functions. Pulse (Basel) 2016; 3 (3–4): 190–194, doi: 10.1159/000443615.
3. Švihovec J., Bultas J. Farmakologie. Grada, Prague, 2018.