Key result
Pharmacological reduction of heart rate in patients with hypertension, stable coronary artery disease, and heart failure with preserved ejection fraction lacks clear prognostic benefit and may cause adverse hemodynamic effects.
Why the study?
While elevated heart rate is an established negative prognostic predictor, the feasibility and prognostic effects of pharmacological heart rate reduction in patients with HTN, CAD, and/or HFpEF remain unclear.
Does pharmacological heart rate reduction improve adverse outcomes in patients with hypertension, coronary artery disease, and/or heart failure with preserved ejection fraction?
Does pharmacological heart rate reduction improve adverse outcomes in patients with hypertension, coronary artery disease, and/or heart failure with preserved ejection fraction?
Unlike in HFrEF, pharmacological heart rate reduction in patients with hypertension, stable CAD, or HFpEF lacks clear prognostic benefit and may have adverse hemodynamic consequences, suggesting elevated heart rate is a risk marker rather than a modifiable risk factor.
Heart rate reduction should not be targeted in these patients; leaves open whether elevated rate is a modifiable factor or risk marker.
Numerous studies have demonstrated the negative prognostic value of tachycardia, both in the general population and in specific subgroups, including patients with coronary artery disease (CAD), arterial hypertension (HTN) and heart failure with preserved ejection fraction (HFpEF). In the latest edition of the European guidlines for the treatment of HTN the level of heart rate (HR) exceeding 80 beats per minute is highlighted as a separate independent predictor of adverse outcomes. However, the feasibility of pharmacological reduction of HR in patients with sinus rhythm is unclear. Unlike patients with reduced ejection fraction, in whom the positive effects of HR reduction are well established, the data on the effect of pharmacological HR reduction on the prognosis of patients with HTN, CAD and/or HFpEF are not so unambiguous. Some adverse effects of pharmacological correction of HR in such patients, which may be caused by a change in the aortic pressure waveform with its increase in late systole in the presence of left ventricular diastolic dysfunction, are discussed. The reviewed data underline the complexity of the problem of clinical and prognostic significance of increased HR and its correction in patients with HTN, stable CAD and/or HFpEF.
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Кохан et al. (2019) conducted a review in Hypertension, coronary artery disease, heart failure with preserved ejection fraction. Pharmacological heart rate reduction was evaluated. Pharmacological reduction of heart rate in patients with hypertension, stable coronary artery disease, and heart failure with preserved ejection fraction lacks clear prognostic benefit and may cause adverse hemodynamic effects.
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