Heart Rate and Hypertension: Risk Factor or Risk Marker?

An elevated heart rate (>= 70/min) is a well-known risk factor in patients with a coronary heart disease and congestive heart failure. However, the relevance of increased heart rate in the general population and in patients with uncomplicated hypertension has not been clarified. Epidemiological studies have shown the association between elevated heart rate and increased mortality and morbidity in hypertensive patients. Consequently, elevated heart rate is at least a risk marker in this population. Nevertheless, there are still no data available which show any independent influence of heart rate reduction by drugs on outcome. Therefore, in stable and asymptomatic patients with hypertension without heart failure and/ or coronary heart disease an increased heart rate is an indicator/marker that these patients have an increased cardiovascular risk. All known treatable risk factors (hypertension, increased body weight, blood sugar, LDL levels, nicotine abuse etc) have to be treated first-line. Increased heart rate is not yet a primary medical treatment goal in stable asymptomatic hypertension. But it can be necessary if tachycardia-dependent symptoms occur.