Hypertension with Elevated heart rate (HR) is not just a physiological
metric—it’s a marker of increased cardiovascular risk. Here’s what recent
research tells us:
Incorporating HR management into ASCVD care can:
Start integrating HR management into your practice to make a real-world difference for your
patients.
1. Grassi G, et al. Association between the European Society of Cardiology/European Society of hypertension heart rate thresholds for cardiovascular risk and neuroadrenergic markers. Hypertension. 2020
Aug;76(2):577-582.
2. Mancia G, et al. Elevated heart rate and cardiovascular risk in hypertension. J Hypertens. 2021 Jun 1;39(6):1060-1069.
3. Grassi G, et al. High blood pressure with elevated resting heart rate: a high risk "Sympathetic" clinical phenotype. Hypertens Res. 2023 Oct;46(10):2318-2325.
4. Raisi-Estabragh, et al. Age, sex and disease-specific associations between resting heart rate and cardiovascular mortality in the UK BIOBANK. PLoS One. 2020; 15(5): e0233898
1
2
Reduce the burden of cardiovascular events.
Improve patient outcomes through targeted therapeutic interventions.
MSNA (bs/min)
NE (pg/ml)
Hypertension with Elevated HR drives sympathetic overdrive
consistently over 24 hours 1
100
80
60
40
20
0
700
600
500
400
300
200
100
0
24
Hour
HR
<80 b/min
HR
80 b/min
**
HR
<80 b/min
HR
80 b/min
MSNA, muscle sympathetic nerve traffic; NE, venous plasma norepinephrine; Bs/min, bursts/min.
Patients with Hypertension with elevated HR (>80 bpm) have a
significantly higher hazard ratio for adverse cardiovascular events,
including myocardial infarction and stroke.2,3
0.9 1.0 1.40.8 1.1 1.2 1.3
All-cause
mortality
All-cause
mortality
CV mortality CV mortality
**
ONTARGET/TRANSCEND – patients with CVD
Major CV events
Myocardial infarction
Stroke
Hosp for HF
CV mortality
All-cause mortality
ADVANCE – patients with diabetes mellitus
CV events
CV mortality
All-cause mortality
CHARM – patients with HF
CV mortality or hosp for HF
All-cause mortality
VALUE– HT patients with high CV risk
Cardiac events
Stroke
Myocardial infarction
Heart failure
Sudden cardiac death
All-cause mortality
LIFE – HT patients with LVH
CV mortality
All-cause mortality
Hazard ratio [95% confidence interval]
1.10 [1.08-1.12]
1.04 [0.99-1.08]
1.01 [0.97-1.06]
1.18 [1.13-1.23]
1.16 [1.12-1.19]
1.14 [1.11-1.17]
1.08 [1.02-1.14]
1.16 [1.07-1.25]
1.15 [1.08-1.21]
1.07 [1.04-1.10]
1.06 [1.02-1.10]
1.16 [1.12-1.20]
1.09 [1.03-1.16]
1.10 [1.04-1.27]
1.24 [1.18-1.30]
1.18 [1.10-1.28]
1.19 [1.15-1.23]
1.16 [1.06-1.27]
1.25 [1.17-1.33]
metric—it’s a marker of increased cardiovascular risk. Here’s what recent
research tells us:
Incorporating HR management into ASCVD care can:
Start integrating HR management into your practice to make a real-world difference for your
patients.
1. Grassi G, et al. Association between the European Society of Cardiology/European Society of hypertension heart rate thresholds for cardiovascular risk and neuroadrenergic markers. Hypertension. 2020
Aug;76(2):577-582.
2. Mancia G, et al. Elevated heart rate and cardiovascular risk in hypertension. J Hypertens. 2021 Jun 1;39(6):1060-1069.
3. Grassi G, et al. High blood pressure with elevated resting heart rate: a high risk "Sympathetic" clinical phenotype. Hypertens Res. 2023 Oct;46(10):2318-2325.
4. Raisi-Estabragh, et al. Age, sex and disease-specific associations between resting heart rate and cardiovascular mortality in the UK BIOBANK. PLoS One. 2020; 15(5): e0233898
1
2
Reduce the burden of cardiovascular events.
Improve patient outcomes through targeted therapeutic interventions.
MSNA (bs/min)
NE (pg/ml)
Hypertension with Elevated HR drives sympathetic overdrive
consistently over 24 hours 1
100
80
60
40
20
0
700
600
500
400
300
200
100
0
24
Hour
HR
<80 b/min
HR
80 b/min
**
HR
<80 b/min
HR
80 b/min
MSNA, muscle sympathetic nerve traffic; NE, venous plasma norepinephrine; Bs/min, bursts/min.
Patients with Hypertension with elevated HR (>80 bpm) have a
significantly higher hazard ratio for adverse cardiovascular events,
including myocardial infarction and stroke.2,3
0.9 1.0 1.40.8 1.1 1.2 1.3
All-cause
mortality
All-cause
mortality
CV mortality CV mortality
**
ONTARGET/TRANSCEND – patients with CVD
Major CV events
Myocardial infarction
Stroke
Hosp for HF
CV mortality
All-cause mortality
ADVANCE – patients with diabetes mellitus
CV events
CV mortality
All-cause mortality
CHARM – patients with HF
CV mortality or hosp for HF
All-cause mortality
VALUE– HT patients with high CV risk
Cardiac events
Stroke
Myocardial infarction
Heart failure
Sudden cardiac death
All-cause mortality
LIFE – HT patients with LVH
CV mortality
All-cause mortality
Hazard ratio [95% confidence interval]
1.10 [1.08-1.12]
1.04 [0.99-1.08]
1.01 [0.97-1.06]
1.18 [1.13-1.23]
1.16 [1.12-1.19]
1.14 [1.11-1.17]
1.08 [1.02-1.14]
1.16 [1.07-1.25]
1.15 [1.08-1.21]
1.07 [1.04-1.10]
1.06 [1.02-1.10]
1.16 [1.12-1.20]
1.09 [1.03-1.16]
1.10 [1.04-1.27]
1.24 [1.18-1.30]
1.18 [1.10-1.28]
1.19 [1.15-1.23]
1.16 [1.06-1.27]
1.25 [1.17-1.33]
