Key result
Hypertension guidelines overlook elevated RHR as a CV risk factor affecting ~34% of hypertensive patients.
Why the study?
Increased resting heart rate impairs prognosis in arterial hypertension, but whether clinical guidelines acknowledge its significance and provide recommendations for threshold and target values remains unclear.
Is the significance of high resting heart rate adequately addressed in current hypertension guidelines?
Is the significance of high resting heart rate adequately addressed in current hypertension guidelines?
Current hypertension guidelines largely fail to address the significance of elevated resting heart rate, highlighting a gap in clinical recommendations.
Answers are grounded in this paper and cite their sources.
Elevated resting HR warrants clinical attention in hypertension; challenges guidelines and leaves open benefit of HR reduction.
It is widely recognized that not only high blood pressure (BP) but also increased resting heart rate (RHR) impairs prognosis in patients with arterial hypertension (HTN). This study aims to answer 5 questions regarding the guidelines on HTN: 1. ‘Is the significance of high RHR in HTN acknowledged?’; 2. ‘Is there a recommendation to decrease RHR in chronic antihypertensive treatment?’; 3. ‘Which antihypertensive medication is preferred to diminish high RHR in HTN patients?’ 4. ‘What is the treatment threshold value of RHR in patients with HTN?’ and 5. ‘Is there a recommendation for target RHR in chronic treatment of HTN?’. The significance of RHR and the treatment approach to it are scarcely mentioned in the key publi-cations—the guidelines on HTN—and there is no obvious firm argument to omit recommen-dations related to threshold and target RHR in HTN patients. On the contrary, there are at least five (major) reasons for addressing increased RHR in HTN guidelines. The vast majority of HTN guidelines do not acknowledge the significance of RHR elevation (as a cardiovascular risk factor). This discrepancy affects as much as 30-38% of the hypertensive population (that is, global > 1.28 billion adults – according to the World Health Organization). We highlight the need for improvement in the forthcoming guidelines that (in the current versions) do not explain the importance of RHR in HTN. Additional investigations are needed to confirm whether reducing high resting heart rate in HTN patients improves prognosis.
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Koraćević et al. (2026) studied this question. Current hypertension guidelines largely fail to acknowledge elevated resting heart rate as a cardiovascular risk factor, a discrepancy affecting 30-38% of the hypertensive population.
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