Management of patients with arterial hypertension and heart rate over 80 bpm: resolution of the expert council

Сlinical and population studies have shown that elevated heart rate (HR) in patients with arterial hypertension significantly increases the risk of organ damage, development of cardiovascular events and overall mortality. Therefore, measurement of resting HR should be a component of standard hypertensive patients examination. This simple parameter was shown to reliably reflect sympathetic nervous system activity. A cutoff point for resting HR over 80 beats per minute (bpm) has been proposed to be a marker of sympathetic overdrive and an independent cardiovascular risk factor. However, the rationale and target for HR reduction in hypertension without cardiovascular diseases are still controversial. It is necessary to take into account the tolerance of tachycardia, blood pressure level, the HR level and comorbidity before starting HR reduction therapy. Increased resting HR may be a clinical sign of sympathetic overdrive, but also a symptom of anemia, thyrotoxicosis, hypovolemia, chronic heart failure, and other conditions. It is also necessary to consider patient’s metabolic status and lifestyle. Thе review summarizes expert council opinion on the management of patients with hypertension and HR over 80 bpm, including the issue of beta-blocker indications.