The prognostic significance of heart rate for cardiovascular disease and hypertension.

Five decades ago, hypertension was a debated risk factor for the development of cardiovascular disease. After further studies and the introduction of antihypertensive medications, few, if any, have doubted the important role hypertension plays as a cardiovascular risk factor. Today, a growing body of evidence emphasizes the relationship between heart rate and hypertension, and heart rate and cardiovascular disease, which makes the measurement of heart rate an important component of the cardiovascular risk assessment. Current European guidelines for managing arterial hypertension recommend the measurement of heart rate for risk stratification, but there still are no recommendations for treatment. This review discusses the evidence for a relationship between heart rate and cardiovascular mortality and morbidity and hypertension.

[A man in his sixties with myocardial infarction, stent thrombosis and haemorrhage]. / En mann i 60-årene med hjerteinfarkt, stenttrombose og blødning.

A man in his sixties had acute ST-elevation myocardial infarction (treated with PCI [percutaneous coronary intervention] and antithrombotic medication) complicated by recurrent stent thrombosis. Excessive haematuria and discovery of a urinary bladder cancer complicated the antithrombotic treatment. Due to recurrent stent thrombosis the patient underwent a total of four PCIs and received the glycoprotein IIb/IIIa-inhibitor abciximab on two occasions. After the last administration of abciximab he developed excessive bleeding within an hour; a blood sample revealed severe thrombocytopenia (2 x 10(9)/l). Severe thrombocytopenia is a rare, but well-known complication to glycoprotein IIb/IIIa-inhibitor treatment and is most often seen after readministration of abciximab. The problem of recurrent coronary stent thrombosis was solved by aorto-coronary bypass surgery, which should always be considered in patients with recurrent stent thrombosis and complications to anti-thrombotic treatment. When bleeding occurs in connection with abciximab treatment, especially within the first month after previous treatment, severe thrombocytopenia should always be considered as a possible cause. Abciximab should be avoided in patients with a history of severe abciximab-related thrombocytopenia.

High heart rate as predictor of essential hypertension: the hyperkinetic state, evidence of prediction of hypertension, and hemodynamic transition to full hypertension.

Although essential hypertension seems to have a strong hereditary component, the triggering mechanism is unclear. It is likely that the central nervous system via autonomic sympathetic overactivation plays a key role in the development of hypertension. High heart rate has proven to be a strong predictor for cardiovascular disease and a predictor of the development of essential hypertension. Because heart rate is highly influenced by many factors such as anxiety and physical activity, it is sometimes difficult to interpret the value of heart rate measurement in individual persons. Whether heart rate itself is a risk factor for development of hypertension or just a marker for sympathetic overactivation is still a matter of debate, but the presence of elevated heart rate in both hyperkinetic and hypertensive subjects makes it an interesting and easy measurable prognostic marker.