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Potential interests of heart rate lowering drugs
  1. T Laperche,
  2. D Logeart,
  3. A Cohen-Solal,
  4. R Gourgon
  1. Cardiology Department, Hôpital Beaujon, 100 bd du Général Leclerc, Clichy, France
  1. Dr T Laperche, Centre Cardiologique du Nord, 32-36 rue des Moulins Gémeaux, 93200 Saint Denis, France.

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Epidemiological studies have shown that a high heart rate at rest is a risk factor for global and cardiovascular mortality.1-3 A rapid heart rate is associated with a variety of prognostic factors indicative of worse heart conditions (for example, hypoxaemia, anaemia, alcohol consumption, low physical training status). The link between a high resting heart rate and an increase in overall and cardiovascular mortality has, however, been shown to be independent of cardiac conditions that can contribute to an increase in the resting heart rate, and persists after adjustment for other classic variables (sex, arterial pressure, and alcohol consumption).2 ,3

Recently, an elegant study showed that, among mammals, the relation between the number of beats per lifetime and life expectancy was remarkably constant, and the provocative question was raised as whether human life could be extended by slowing the heart rate.4Of course, such a study using bradycardiac drugs has not yet been performed, but these data point to the potential beneficial effect of heart rate lowering drugs in patients with cardiac disorders. This review examines the impact on the cardiovascular system of treatments which lower the heart rate.

Heart rate and vascular structure and function


Arterial mechanical properties are determined by elastic, viscous, and inertial components of the vessel wall. The duration of the distension recoil cycle potentially affects arterial function. In vitro, the mechanical properties of the large arteries, particularly the incremental elastic modulus, index of arterial stiffness, are frequency dependent and may be influenced by the resting heart rate. In animal studies, pace induced tachycardia is associated with reductions in arterial compliance and distensibility, with a greater effect in carotid than in femoral arteries.5 A recent clinical study in humans has shown a positive correlation between high heart rate and high arterial stiffness.6 However, the beneficial effect of heart …

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