Abstract

PHARMACOLOGICAL HEART RATE LOWERING IN PATIENTS WITH A PRESERVED EJECTION FRACTION

Shaikh A. K.*, Ajgunde B. R.* and Bawage S. B.*

ABSTRACT

Epidemiological studies have shown that high heart rate is associated with increased mortality. Clinical studies in patients with heart failure and reduced ejection fraction have shown that heart rate with beta-blockers and ivabradine improves survival. It is therefore commonly thought that lowering the heart rate is beneficial for some patients as well. Here we critically analyze the effects of pharmacological heart rate reductions in patients with a share of normal and reduced ejection output with an emphasis on pharmacological heart rate effects to reduce high blood pressure and heart failure. Emerging evidence from recent clinical trials and meta-analyzes suggests that lowering the heart rate chemically is not beneficial for patients with a normal or stored withdrawal component. This has recently begun to appear in some but not all recommendations. The harmful effects of decreased pharmacological heart rate are due to an increase in moderate blood pressure, left ventricular elevation of systolic and diastolic pressure and an increase in ventricular wall pressure. Therefore, we suggest that lowering the heart rate per seam produces hemodynamic effects of diastolic dysfunction and puts increased arterial load on the left ventricle, which in turn increases the risk of heart failure and atrial fibrillation. Pharmacologic heart rate reduction is clearly beneficial in patients with extended cardiomyopathy but not in patients with normal chamber size and normal systolic function. These contradictory effects can be explained based on a model that considers the effects of hemodynamic and ventricular structure of heart rate changes.

Keywords: Heart Rate; Hypertension; Heart Failure; Adrenergic Beta-Antagonist.