ABSTRACT
INTRODUCTION Hypertension is one of the most important risk factors for atherosclerosis and cardiovascular disease. However, in the past decades it appeared clearly that hypertensive subjects often exhibit several other risk factors for atherosclerosis such as high heart rate, overweight, and metabolic disturbances (1,2). This may explain why the reduction in coronary events obtained with antihypertensive treatment was smaller than expected. Although the association of hypertension with tachycardia and metabolic abnormalities has long been recognized, the reason for this clustering of risk factors in subjects with hypertension has not been fully understood. Although overwhelming evidence from most studies has shown that heart rate is a powerful, independent, and consistent predictor of cardiovascular events and all-cause mortality, it is still considered an epiphenomenon of a general disorder rather than an independent risk factor (3). The reason why heart rate has been and continues to be underestimated in patients without cardiac disease, in spite of its predictive value being significant after taking into account all the main risk factors, may be due to the lack of studies showing a beneficial effect of heart rate lowering in hypertension. In this chapter, we will review the results from epidemiological studies and clinical trials looking at the relationship between heart rate and cardiovascular risk in hypertension and other clinical settings. We will also explore the complex pathophysiological mechanisms underlying this association. Finally, we will focus on therapeutic aspects, because the key objective for the clinician is to establish whether heart rate reduction can reduce cardiovascular morbidity in hypertension and other pathological conditions.
