Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland.
Cardiol J. 2020;27(6):857-867. doi: 10.5603/CJ.a2019.0021. Epub 2019 Feb 25.
Early detection and management of elevated blood pressure is crucial in reducing the burden of cardiovascular disease (CVD). The importance of an absolute risk assessment and patient risk stratification has been highlighted in the European hypertension guidelines since 2003. Amongst numerous risk factors influencing patient prognosis, elevated heart rate (HR) has been indicated as important predictor of future risk of hypertension, coronary heart disease, sudden cardiac death, heart failure, CVD, stroke, total cancer and mortality. Given that resting HR can be easily determined in clinical practice and modified by lifestyle changes as well as beta-blocker therapy, it seems reasonable that lowering resting HR should be a potential target to reduce disease burden and premature mortality. However, there is a lack of outcome studies of HR lowering in tachycardia-related hypertension. This review outlines the underlying mechanisms of early course hypertension pathophysiology with the critical role of the sympathetic nervous system activation, the prognostic significance of fast HR and the mechanistic rationale for the use of non-pharmacological approaches and/or highly long-acting cardioselective beta-blockers with some consideration given to betaxolol properties.
早期发现和管理高血压对于降低心血管疾病（CVD）负担至关重要。自 2003 年以来，欧洲高血压指南强调了绝对风险评估和患者风险分层的重要性。在影响患者预后的众多危险因素中，心率（HR）升高已被认为是高血压、冠心病、心源性猝死、心力衰竭、CVD、中风、总癌症和死亡率的重要预测因素。鉴于静息 HR 可以在临床实践中轻松确定，并且可以通过生活方式改变和β受体阻滞剂治疗来改变，因此降低静息 HR 似乎是降低疾病负担和过早死亡的潜在目标。然而，在与心动过速相关的高血压中，降低 HR 的结果研究较少。本综述概述了早期高血压病理生理学的潜在机制，其中交感神经系统激活起着关键作用，快速 HR 的预后意义以及使用非药物方法和/或具有某些考虑因素的高度长效心脏选择性β受体阻滞剂的机制合理性贝他洛尔的特性。
