When an Increase in Central Systolic Pressure Overrides the Benefits of Heart Rate Lowering.
Publisher DOI
PubMed ID
27515336
Abstract
An elevated resting heart rate has been unequivocally linked to adverse cardiovascular events. Conversely, a physiologically low heart rate may confer longevity benefits. Moreover, pharmacological heart rate lowering reduces cardiovascular outcomes in patients with heart failure, with the magnitude of the reduction associated with survival benefit. In contrast, pharmacological heart rate lowering paradoxically increases cardiovascular events in hypertension, possibly because it elicits a ventricular-vascular mismatch, leading to increased central systolic blood pressure (BP). By the same hemodynamic mechanism, pharmacological heart rate lowering also engenders an increase in central (aortic) BP in coronary heart disease and, as a consequence, fails to decrease myocardial oxygen consumption. Whether in heart failure, hypertension, or coronary heart disease, or even athletes, heart rate lowering consistently increases central systolic pressure. The increase in central systolic BP is prone to abolish the potential benefits of heart rate lowering interventions, possibly accounting for failure to reduce outcomes in patients with hypertension and coronary artery disease.
Date Issued
2016-08-16
Publication Type
Article
Subject(s)
Subjects
beta-blockers
•
blood pressure
•
coronary artery disease
•
heart failure
•
hypertension
•
ivabradine
Language(s)
en
Author(s)
Messerli, Franz H | |
Bangalore, Sripal | |
Bavishi, Chirag | |
Laurent, Stephane |
Additional Credits
Journal
Journal of the American College of Cardiology
Publisher
Elsevier
ISSN
0735-1097
Access(Rights)
restricted