Heart rate as a therapeutic target in hypertension

A number of studies have shown that a faster resting heart rate is associated with higher blood pressure, and is prospectively related to the development of hypertension and cardiovascular events. Hypertensive subjects with tachycardia often also exhibit overweight, higher haematocrit, plasma insulin, LDL-cholesterol and triglycerides whereas HDL-cholesterol is decreased. Sympathetic overactivity seems to be responsible for both the increase in heart rate and blood pressure and for the metabolic abnormalities. Experimental studies in monkeys have shown that reduction of heart rate could retard the development of atherosclerotic coronary lesions. Although reduction of heart rate appears as an additional goal of antihypertensive therapy, several drugs which lower heart rate have unfavourable effects on patients' metabolic profile. Phenylalkylamines are devoid of this untoward effect, but their negative inotropic activity makes them unsuitable for patients with impaired left ventricular function, a condition which may also be present in the initial stages of arterial hypertension.