Journal of Hypertension: December 2016 - Volume 34 - Issue 12 - p 2330–2332

Brian TOMLINSON,a Piyamitr SRITARA,b Eleanor LOPEZ,c Jamshed DALAL,d Erwinanto ERWINANTO,e Arvind K PANCHOLIAf

Full text article

Summary

Most studies that show a relationship between resting heart rate (HR) and clinical outcomes in patients with hypertension, including those discussed in the European Society of Hypertension (ESH) guidelines, have been performed in predominantly Caucasian populations, with a paucity of data in Asian populations. With a view to gaining insight into evidence from patients in the Asia Pacific region, a consensus meeting was held in Mumbai, India during the Asia Pacific Conference on Cardiometabolic Diseases Management in July, 2015. This meeting brought together the rich experience of an expert forum of cardiologists and other hypertension specialists who discussed and debated the role of elevated HR in hypertension and cardiovascular morbidity. For the purpose of this commentary, an extensive literature review was also conducted to gather more information on patients with hypertension and elevated HR from the Asia Pacific region.

Preliminary studies from China, Japan, and India support an association between elevated HR, hypertension, and cardiovascular morbidity. The expert forum considered elevated HR as a potential risk factor for cardiovascular events and mortality. The forum agreed that HR should be monitored in patients with a high risk of cardiovascular disease and that HR lowering could be considered as a treatment strategy in these patients, but were undecided on whether reducing HR in hypertension has long-term benefits because of the lack of prospective clinical trials to address this issue. Regarding the definition of tachycardia, the forum agreed with the ESH consensus that, in the absence of specific data to determine this criterion, any threshold used to define tachycardia is arbitrary but a value ≥80 bpm is compatible with published data. In symptomatic tachycardia, HR reduction by available drugs (mostly beta-1 selective beta blockers) should be considered. This forum recommended that resting HR should be considered as an independent risk factor for cardiovascular events and mortality, country guidelines should be updated to include resting HR monitoring, and pharmacotherapy should be considered in high-risk hypertensive patients with elevated HR. The forum also concluded that further clinical studies are needed to provide evidence to support the optimum HR to be achieved and to evaluate if the effects of HR reduction in hypertensive patients with elevated HR (≥80 bpm) have long-term benefits. Such studies could help to define treatment approaches to optimize the management of hypertension with HR elevation.