High Heart Rate, Sympathetic Overdrive, and Cardiovascular Risk in Hypertension

Elevated resting heart rate values accompanying essential hypertension are frequently detected in current clinical practice. Evidence shows that a heart rate greater than 80 beats/minute is triggered by pronounced sympathetic overactivity with adverse cardiovascular outcomes. These include the development and progression of hypertension-mediated organ damage, such as cardiac hypertrophy, endothelial dysfunction, impaired arterial distensibility, pro-atherogenic vascular alterations, and renal damage. They also include a greater risk of cardiovascular morbid events, such as myocardial infarction, chronic heart failure, and stroke, independent of other concomitant risk factors. Finally, they are associated with increased cardiovascular mortality. In conclusion, the present paper will provide a comprehensive in-depth review of the pathophysiological background, clinical impact, and therapeutic consequences of an elevated resting heart rate value as an independent cardiovascular risk factor in hypertension.